Table of Contents Appendix A I. IX
Appendix
B: The Aging Process and Physiological Functioning
I. II. III.
Appendix C: Miscellaneous Items
I. Proposed Human Factors Handbook
II.
Aging Scenarios Data Needs
III.
Medical Conditions, Functional Disabilities and Operator
Performance
IV. Appendix D I. II.
Appendix A: Ongoing Research Programs (A1)
I. National Highway Traffic Safety Administration (NHTSA) (A2)
NHTSA continues to pursue implementation of its Traffic Safety
Plan for Older Persons (DOT HS 807 316). The plan was originally
developed in 1988 in response to the Transportation Research Board
publication, Transportation in an Aging Society. An update completed in
1993, at the request of Congress, outlines major agency efforts to improve the
safety of older drivers, vehicle occupants, and pedestrians. Current and
upcoming projects are described below. NHTSA's ongoing research can be
categorized as follows:
Research on Problem Identification
Establish the Crash Risk for Specified Medical/Functional Conditions.
This interagency agreement with Oak Ridge National Laboratories is identifying
existing databases and conducting secondary analyses to better identify older
driver issues. Analyses currently underway will identify older driver problem
groups requiring special attention. Anticipated completion date is 1997.
Principal Investigator: Pat Hu, Oak Ridge National Laboratories (423)
574-5284.
A Model System to Improve Self and Institutional Regulation of
Driving by Older People. Older driver groups who need assistance determining
when to stop or alter their driving are being identified, along with support
resources in the social service and aging network who come into contact with
them and can provide needed assistance. Guidelines for detecting limitations and
for providing help in driving decisions are being developed. Anticipated
completion date: 1997. Principal Investigator: R.O.W. Sciences, Inc. (301)
294-5471.
Analyze Vehicle Crash Worthiness for Older Occupants. NHTSA is
analyzing crash data to compare injuries received by older and younger motor
vehicle occupants restrained by lap and shoulder belts and/or air bags. Since
older persons are more likely to be involved in side-impact crashes, changes in
injury patterns are being monitored over the next few years as the new
side-impact regulation, requiring manufacturers to install side padding and
structural improvements, is phased in. Anticipated completion date: Ongoing.
Contact: Cathy McCullough, NHTSA (202) 366-4734.
Intersection Negotiation Problems of Older Drivers. The causes of
older driver problems at intersections, especially those involving left turns,
are being investigated. Findings will be used to develop new information and
training materials for older drivers. Anticipated completion date: 1997.
Principal Investigator: Loren Staplin, Scientex Corp. (215) 412-4912.
Family and Friends Reporting and Assisting Problem Older Drivers.
Guidelines and program materials are being developed to facilitate involvement
by family and friends in the driving decisions of problem older drivers. Focus
groups are underway to explore how family and friends help high-risk older
drivers and how to overcome barriers to their involvement. An in-depth survey of
eight state licensing agencies is being initiated to examine actual experiences
with family, friends and others reporting potentially unsafe older drivers to
state authorities. Surveys have been conducted with professionals involved with
or concerned about older driver safety to determine information and resource
needs. Anticipated completion date: December 1996. Principal Investigators:
Ronni and Harvey Sterns, LIFESPAN Associates Inc. (330) 867-6336.
Older Driver Family Assistance. The 402 project will identify and
develop strategies to help families assist older persons with driving
difficulties. Barriers to family involvement and the role of safety and other
professionals in supporting concerned family members are being determined. A
handbook will be developed of recommended strategies to assist families. Results
will be incorporated into a preexisting care giver assistance program in New
York. Anticipated completion date: 1997. Project Leader: Philip LePore, New York
State Department of Aging (518) 486-2727.
Identify Specific Vehicle Design Practices that Enhance Older Driver
Crash Avoidance. NHTSA is examining vehicle design practices and
advanced-technology crash-avoidance countermeasures to determine which have the
greatest safety potential for older drivers. Specific practices and
countermeasures will be recommended. (As a standard practice, NHTSA considers
the needs and functional limitations of older drivers in virtually all of its
crash avoidance research.) Anticipated completion date: Ongoing. Contact:
Michael Perel, NHTSA (202) 366-5675.
Program Development
Update National Medical Standards and Examiner Training Programs.
Findings and conclusions of current research and literature will be used to
refine existing and develop new medical standards for physicians and other
practitioners to use in identifying high-risk problem drivers. State licensing
agencies will be provided with an updated guidebook, "Functional Aspects of
Driver Impairment - A Guide for State Medical Advisory Boards," which includes
recommended medical standards for making licensing decisions. Support is also
being provided to the AAMVA for updating information on older drivers contained
in training materials developed for driver license examiners. Anticipated
completion date: 1997. Principal Investigator: Elaine Petrucelli, Association
for the Advancement of Automotive Medicine (847) 390-8927.
Develop Performance Assessment Techniques. Under a cooperative
agreement with the California Department of Motor Vehicles, tests are being
selected and designed to evaluate the status of drivers with dementia or
age-related frailties. Anticipated completion date: Summer 1997. Principal
Investigator: Mary Janke, California DMV (916) 657-7032.
Health Community Involvement with Problem Older Drivers. Health care
disciplines that have contact with problem older drivers will be identified, and
ways will be assessed in which they can be more involved in advising their
patients/clients about driving modifications and reporting them, as needed, to
appropriate state authorities. A "how to" kit will be developed for health care
providers working with older drivers and families on needed driving adjustments.
Anticipated start date: April 1997.
Model Driver Screening and Evaluation Program. Recently created
screening and assessment procedures will be identified, evaluated and classified
by purpose and target conditions. The degree to which the procedures are
suitable for (or adaptable to) making recommendations about driving decisions
and licensing actions will be determined. Testing procedures will be modified or
developed, as needed, and pilot tested. Anticipated completion date: Spring,
1996. Principle Investigator, Loren Staplin, (215) 412-4912
Validate Statistical Models Relating Functional Limitations to
Driving Cessation and Crash Involvement. Models of driving cessation and crash
involvement developed by Oak Ridge National Laboratories with the Iowa EPEE data
will be validated with additional data bases for another location (Salisbury,
MD). Anticipated completion date: Summer 1997, Johns Hopkins University, Gary
Rubin, (410) 550-6429
Improve Safe Mobility of Older Persons. Funded by NHTSA and the
Federal Highway Administration, this study will establish requirements for
identifying, developing, demonstrating and implementing measures that would
allow older persons to safely extend their driving years. Research thrusts
address: improved driving skills, driver assessment, cognitive retraining,
technology-based cognitive aids, enhanced the assisting nature of
transportation, and use of emerging technology as a potential surrogate for
certain types of travel. Anticipated completion date: Summer 1997. Ed Crow (814)
863-9887
II. Federal Highway Administration (FHWA)(A3)
Improved Highway Travel for an Aging Population. In 1989 a
High Priority Area was initiated by the Federal Highway Administration's Human
Factors Safety Research Program to address problems faced by older road users.
The urgency of the program was spurred by the nation's population increase in
people over age 65, especially the estimated projection that this segment of the
population will total more than 65 million people by the year 2030. In addition,
research shows older drivers are over-represented in traffic fatalities.
Although older drivers drive fewer miles than younger drivers (age 35 and
under), their fatality rate is much higher. Age related changes in cognitive
functioning, perception, and psychomotor limitations are issues currently
addressed in studies examining countermeasures under this High Priority Area.
The studies being conducted will identify, develop, and evaluate a variety of
engineering enhancements to the highway system to meet the needs of older road
users.
Results of many of the studies include recommendations for practical
and implementable changes that will help improve performance of all drivers,
including those over 65. It is expected that improvements resulting from this
program can be implemented before the United States population's average age
increases significantly. A discussion of the completed and the current studies
follows:
Traffic Maneuver Problems of Older Drivers. Since little was known
about the specific changes in driving abilities as people age, this study was
conducted to examine the limitations and capabilities of older drivers to
perform important driving maneuvers required for driving on modem roadways. The
feasibility of employing non-interactive videodisc (or other) technology for
testing the laboratory performance of drivers with diminished capacity was also
investigated. This study identified the most critical limitations and
capabilities of older drivers. Analyses support the hypothesis that older
drivers are over- represented in accidents as a result of turning and merging
maneuvers.
It was also found that older drivers do not overestimate the
time-to-collision for vehicles approaching either head-on or on an intersecting
path, leading to consideration for other hypotheses for older drivers'
involvement in these types of accidents. In addition, the study found that
subjects' responses to laboratory stimuli using 35 mm film were comparable to
field data responses, indicating the utility of this medium. Guidelines for
design changes for highway design and traffic control devices were recommended
to enhance older drivers' mobility. One example of a recommended guideline
included implementing highway elements at intersections to identify conflict
vehicles that are approaching at high speed. The study has been completed and
has been published by FHWA (Publication No. FHWA-RD-92-092).
Older Driver Perception Reaction Time for Intersection Sight Distance
and Object Detection. Current American Association of State Highway and
Transportation Officials (AASHTO) values for sight distance were hypothesized as
not fully addressing increased reaction times which may be a part of age-related
changes. This study investigated intersection sight distance, stopping sight
distance, decision sight distance, and gap/lag acceptance by older drivers in
order to assess the appropriateness of current perception reaction time values
used in design equations. In doing this, the researchers also assessed the
utility and feasibility of alternate gap acceptance models for highway and
intersection design. Findings obtained from all drivers (young, middle-age, and
old) supported the appropriateness of the current AASHTO design standards of
2.5 seconds for stopping sight distance and 2. 0 seconds for stop
controlled intersection sight distance. Decision sight distance values, 10.0
seconds for freeways and 1.2 seconds for arterials, were also found to be
adequate. (Publication No. FHWA-RD-93 -168).
Relative Visibility of Increased Legend Size Versus Brighter
Materials. Technology in retro-reflective sheeting materials has improved
greatly through recent years. This study was designed to examine the needs of
older drivers in terms of recognition distance and legibility of signs with
different color backgrounds, different stroke widths of lettering, and different
Manual of Uniform Traffic Control Devices fonts. This study examined older and
younger drivers' responses to brighter signs versus larger signs and evaluated
other characteristics related to lettering (font, spacing, capitalization) under
day and night viewing conditions.
Major findings showed that tested sign materials did not have an
effect on dynamic legibility and construction signs (black lettering on orange)
were found to have greater conspicuity values than regulatory (black on white)
signs. Furthermore, increases in letter height beyond sixteen inches did not
produce significant, additive changes in legibility distance.
Based on the results of the study, engineering guidelines with
recommendations for sheeting material use were produced, as were recommendations
regarding font type and letter spacing to enhance older drivers' abilities to
see and read signs from a greater distance. Economic analysis of sign size
versus retro-reflective materials was another important product of this study.
(Publication No. FHWA-RD-94-035)
Pavement Markings and Delineation for Older Drivers. Older drivers
may need enhanced pavement markings and delineations in order to remain safely
within their lanes and focus on downstream geometry. This study identified and
evaluated situations in which older driver performance may be improved by
enhanced delineation and pavement markings. It also determined the effect of
enhanced delineation and pavement markings on driver behavior, particularly
older drivers. Findings showed that combinations of treatments which included
two elements (both edge line delineation and off-road elements) were more
effective than any single treatment for all age groups. This effect was also
more pronounced for the older drivers.
The chief product of this study is the identification of the
delineation needs of older drivers. Findings show that combinations of
treatments that include two elements (both edge line delineation and off-road
elements) are more effective than any single treatment for all age groups, but
especially for older drivers. Changes to current delineation and pavement
marking treatments based on study findings were also recommended, along with
changes to engineering guidelines for enhanced delineation systems. (Publication
No. FHWA-RD-94-145). Anticipated completion date: Summer 1996. Contact:
Elizabeth Alicandri, FHWA (703) 285-2415.
Symbol Signing Design for Older Drivers. Many symbol signs currently
in use are either confusing, or ambiguous, especially for older drivers. A
number of symbol signs have demonstrated low comprehension due to their complex
design, low conspicuity, and unrecognizableness. This study was conducted to
identify problematic signs, test alternatives, and investigate individual
elements of symbol signs to assess their criticality for good sign design. One
major product also included the development of symbol sign design
guidelines.
Results of this study showed that, on every sign tested, mean
visibility distances were lower for elderly drivers than either young or
middle-aged drivers. Reaction time (for sign recognition) was greatest for the
older drivers and lowest for younger drivers. A process to improve signs used a
Fourier analysis technique that helped to define critical elements for symbol
signs. Based on this technique, a set of redesigned and modified signs was
developed and assessed. Findings for these signs showed that drivers understood
these signs significantly better than the original signs and the recognition
distances increased. Based on these finding, guidelines for symbol sign design
have been developed. Results are currently in publication (Publication No.
FHWA-RD-94-069).
Traffic Operations Control for Older Drivers. Older persons, as
drivers or pedestrians, appear to have disproportionate rates of involvement in
accidents at intersections and other situations. This study was conducted to
define the safety problems of older drivers and pedestrians. Alternative designs
for use in rural and urban settings were evaluated to help accommodate the
perceptual, cognitive, and psychomotor capabilities of older drivers and
pedestrians and make recommendations regarding changes to current standards.
Intersection features examined included traffic signal display type, signal
placement and phasing, off-peak and on-peak operations, day and night
operations, left turn arrows, intersection geometry, and intersection visual
complexity.
Findings showed that one countermeasure developed, a pedestrian
signal education placard, did not change pedestrian behavior at intersections.
In addition, results showed there is a general misunderstanding of the protected
phase of left-turn, protected/permitted signals. Older drivers tend to believe
the permitted phase gives them the right-of-way. Recommended changes to current
intersection traffic control device standards to accommodate older drivers and
pedestrians will be the primary product of this research. (Publication No.
FHWA-RD-94-119). Anticipated completion date: Summer 1996. Contact: Elizabeth
Alicandri, FHWA (703) 285-2415.
Older Pedestrian Characteristics for Use in Highway Design.
Information gaps currently exist on the mental and physical functions essential
for the pedestrian movement of older persons. This is especially apparent at
signalized intersections where older pedestrians have a great deal of difficulty
crossing before the signal changes due to age-related changes in perception,
response time, and motor abilities. This study assessed the current capabilities
of older pedestrians through a task analysis, information gathered from older
pedestrians through surveys and focus groups, and field observation
studies.
Major findings show that, when compared to younger pedestrians, older
pedestrians displayed: (1) crossing start-up times that were approximately
25 percent greater; (2) walking speed that is significantly
slower; and (3) stride lengths that were about 86 percent of younger
pedestrians. Therefore, the observed slower walking speeds of the older
pedestrians may be due to their shorter stride lengths. (Publication No.
FHWA-RD-93-177).
Assessment of the Capabilities of the Iowa Driving Simulator. The
development of the Iowa Driving Simulator (IDS) has the potential to enhance the
FHWA's research capabilities. To ensure the IDS can help in FHWA's human factors
research program, this study was conducted to assess the IDS's capabilities on
several performance dimensions and provide performance data to the FHWA for
further analysis. The results of this study showed that older drivers drove
slower, made significantly more accelerator pedal reversals on the highway
on-ramp than younger drivers, and had less variance in lane placement in the
straight segment when compared to young drivers. The inclusion of intersection
turning maneuvers in the driving scenario was found to be a significant factor
leading to simulator sickness; and self-reported measures proved reliable
indicators of possible sickness onset. In addition, obtained ratings from test
subjects showed the IDS is perceived as having a high degree of realism and
fidelity.
Investigation of Older Driver Freeway Needs and Capabilities.
Freeways are an integral part of an individual's mobility in the United States,
yet it is not known if the required capabilities for using them exceed older
drivers' actual capabilities. This study identified characteristics of drivers
65 years and older that affect their needs and capabilities with regard to
freeway driving. This study also assessed the freeway driving environment
elements which are problematic for drivers 65 and older.
The product of this problem identification research was a delineation
of the problems which confront the older driver on freeways. Future research to
develop guidelines for countermeasures to address problems to accommodate
drivers 65 and over will be recommended. Anticipated completion date: Summer
1996. Contact: Elizabeth Alicandri, FHWA (703) 285-2415.
Delineation of Hazards for Older Drivers. Object markers are used to
delineate obstructions within or adjacent to the roadway. Over the years the
exact meaning of these markers has become unclear. Experts disagree on whether
the markers should convey the presence of an object or a sense of a hazard to
the driver. There is also confusion between the use of object markers and
standard delineation and marking treatments.
This study will achieve four objectives: (1) identify conspicuity,
recognizability, and comprehensibility problems with object markers,
particularly as they relate to the needs and capabilities of the older driver;
(2) determine, through empirical research, the effect of enhancements in the
design and implementation of object markers, including an analysis of the impact
of these changes on the comprehension of other devices; (3) perform cost/benefit
analyses associated with changes in the design and implementation of object
markers; and (4) make recommendations regarding changes to the current design
and implementation of object markers and discuss potential effects of such
changes on safety and traffic operations.
Preliminary results show that subjects correctly comprehended only 36
percent of object markers presented and older drivers produced
significantly more incorrect responses when compared to younger drivers. In
general, findings also showed that hazard markers seemed to have little effect
on subjects' perception of hazards -they had the greatest effect on those
objects that are already conspicuous, such as trees, poles, and bridge
abutments. Finally, the Type 3 markers (vertical, striped) were shown to be more
effective than both Type 1 (yellow diamond) and Type 2 (small yellow
rectangle).
Products that will be developed from this study include: (1) the
identification of recognition, conspicuity, and comprehension difficulties of
object markers for older drivers; (2) cost/benefit analysis of design changes to
object markers; and (3) recommendations for object marker design changes.
Anticipated completion date: Winter 1996. Contact: Elizabeth Alicandri, FHWA
(703) 285-2415.
Intersection Geometric Design for Older Drivers and Pedestrians.
Older drivers' and pedestrians' abilities to safely maneuver through
intersections is of great concern due to the high proportion of accidents and
fatalities occurring at intersections in the older population. This contract
will identify this population's capabilities that most significantly reflect
their needs and impact their abilities at intersections. Results will be used to
identify geometric and operational (e..g., one-way designations, signal
timing, etc.) aspects of intersections that can be modified to better serve
older drivers and older pedestrians.
Products of the project include guidelines for intersection geometric
design and operations that accommodate the needs and capabilities of older
drivers and older pedestrians. Results will also be used to identify those
situations where geometric design and operational changes would intersections or
are not feasible or would not ameliorate problems for older road users at
intersections. Anticipated completion date: Fall 1996. Contact: Elizabeth
Alicandri, FHWA (703) 285-2415.
Integration of Older Drivers and Highway Safety Research. The
improved highway travel for an aging population research area is a comprehensive
and integrated human factors study effort. Due to the number of studies in this
area, there is a need to make the results of these studies accessible to end
users. These end users are identified as the designers and engineers who will
implement changes to current practices for overall improvements to operational
efficiency, highway safety, and driver mobility. In order for the research
findings to be useful to the highway safety community, the findings must first
be synthesized.
Under this contract, all results obtained in the FHWA High Priority
Area titled, "Improved Highway Travel for an Aging Population" and data and
information from other sources will be reviewed. From this, a state-of-the-art
synthesis describing the relationships between older driver needs and
capabilities and highway issues will be developed. These findings will be
extracted and incorporated into handbook format that can easily be used by
engineers. This research will also identify gaps in knowledge. Another product
of this study will be recommendations for a comprehensive research program for
FHWA to implement over the next five to seven years. Anticipated completion
date: Spring 1997. Contact: Joseph Moyer, FHWA (703) 285-2008.
Computer Aided Technique for Optimizing Symbol Signs. This study will
provide for the development of a system using the recursive blurring technique
as an aid for developing, modifying, and improving symbol signs. This
computer-based system will be developed for use by highway sign designers to
provide a more efficient and cost-effective means to ensure high levels of
conspicuity, recognizability, and comprehension can be achieved by drivers.
Anticipated completion date: Spring 1997. Contact: Elizabeth Alicandri, FHWA
(703) 285-2415.
Human Factors Research Program for Advanced Traveler Information
Systems (ATIS) and Commercial Vehicle Operations (CVO)
The FHWA human factors ATIS/CVO research area examines a variety of
human factors issues such as the information requirements of commercial and
private vehicle drivers, display formats, information reliability, and CVO
driver fatigue. Technology and methods for providing drivers the needed
information in a safe and effective manner are studied employing a
human-centered approach. The driver's needs and requirements, rather than
available or projected technology will drive the research for in-vehicle
systems.
Mobility at the Public Service Level. It has been determined that
many of the emerging Intelligent Transportation Society (ITS) systems will
present opportunities for increased mobility and safety for older operators.
Concurrently these same systems can also potentially present safety hazards to
transportation. To address older operator and ITS issues, the ITS of America's
Safety and Human Factors (S&HF) Committee, currently Chaired by Eugene I.
Faber of the Ford Motor Company, has recently initiated a new S&HF
Subcommittee on Older Drivers and ITS. This Older Driver Subcommittee will be
chaired by Allan Tull, Board Member of the American Association of Retired
Persons (AARP). This subcommittee will discuss safety and human factors issues
and opportunities presented by ITS. As a member of the S&HF Committee, the
FHWA has agreed to actively support this new subcommittee. This will be in
addition to FHWA's current support of TRB Committee A3 B13, Older Driver Safety
and Mobility Committee.
These research issues are investigated within the context of a wide
range of services to be provided under ATIS. These include such services as
routing and navigation, motorist services, and safety advisories and warning
systems. These subsystems will be investigated as separate components as well as
part of a fully integrated ATIS. For example, motorists must currently depend on
external roadway signing for routing, warning, regulatory and advisory
information. The signs are expensive to maintain and often cannot be read,
especially by older drivers, at night, or in rain, snow, or under similar
degraded conditions. A major portion of external signing information can
potentially be presented on displays inside the vehicle. However, studies are
needed to assess the needs of drivers in terms of what signing may be displayed,
and how it should be displayed inside the vehicle.
III. Federal Transit Administration(FTA)(A4)
FTA continues to pursue implementation of its age-related
programs. Current and upcoming projects are described below. FTA's on-going
research can be categorized as follows:
Deployment of the Independent Transportation Network. Building on the
results of previous research and experience with the Independent Transportation
Network (ITN), this two-year project is intended to bring the ITN to the point
of financial independence and explore the feasibility of using intelligent
transportation system applications such as smart cards and geographic
information systems to predict future markets. Anticipated completion date:
1998; Project Director: Katherine Freund (207) 828-8608.
IV. DOT/DHHS Coordinating Council on Human Service Transportation(A5)
Mobility Consequences of Relinquishing the Driver License. The
mobility consequences expressed by older persons who reduce or stop driving will
be documented. Anticipated completion date: Winter 1996. Principal Investigator:
Jon Burkhardt, Ecosometrics (301) 652-2414.
V. University Transportation Centers Program (UTCP)(A6)
Enhancing Information Transfer for the Older Driver. Results of
research in sensory and cognitive performance of older drivers over the past
decade will be synthesized and summarized in a design guide for use by municipal
and state traffic engineers. Anticipated completion date: October 1996.
Principal Investigator: Rodger Koppa, Texas A&M University (409)
845-3540.
VI. National Institute on Aging (NIA)(A7)
Current NIA projects are as follows:
Evaluation of a Medical Intervention to Reduce Crash Involvement and Injuries in Older Drivers. The effects of cataract surgery on driving habits, mobility and crash risk are examined for a sample of older adults. Changes in vision, cognition, general and psychological health, driving habits and activities of daily living are evaluated. Principal Investigator: Cynthia Owsley, University of Alabama at Birmingham (205) 325-8635.
Evaluation of a Behavioral Intervention to Reduce Crash Involvement
and Injuries inOlder Drivers. A behavioral testing and retraining program are
being examined to improve visual attention deficits previously shown to be
predictive of crash frequency in older drivers. The project has two primary
objectives: (1) Evaluate the Useful Field of View (UFOV) as a functional
test of driving competence. The UFOV is being evaluated prospectively in
the field to determine its effectiveness as a predictor of driving performance
on the road, simulated driving performance, future vehicle collisions, and
continued mobility. Data on UFOV reductions are being obtained simultaneously
with indices of visual function, mental status and cognitive function to
evaluate batteries of predictors. (2) Evaluate the UFOV as a behavioral
intervention to improve functional skills necessary for
driving competence. The UFOV is being evaluated prospectively at
multiple sites with varying populations to determine whether it can be used
to prolong driving and reduce collisions among older drivers.
Principal Investigator: Karlene Ball, University of Alabama at Birmingham (205)
975-2290.
Objective 1 Evaluation of the UFOV As a Functional Test
This objective is being pursued through collaborative activities as follows:
Salisbury Eye Evaluation Study. This is a large sample epidemiological study which examines the association between specific components of visual loss, including UFOV, and specific types of functional disability. The second wave of data collection is currently underway. To date, results show that each of the vision tests (acuity, contrast sensitivity, disability glare, stereo acuity, visual fields and UFOV loss) are significantly associated with perceived difficulty in driving after adjusting for age, race, gender and education. Multiple regression analyses reveal significant independent contributions of acuity, contrast sensitivity, stereo acuity and visual fields. The findings are consistent with previous results indicating that individuals with reduced attentional function are less aware of their impairments than those with vision losses. Project Leader: Gary Rubin, John Hopkins University (410) 550-6429.
Alzheimer's Disease and Driving Performance. The UFOV is being evaluated as part of a larger study on the effects of Alzheimer's Disease (AD) on driving performance. Participants are in varying stages of the disease and have had in clinic and on-road assessments. Data collection has been completed. Results reported at a recent conference (Alzheimer's Disease and Driving, May 17-18, 1996 at Washington University, St. Louis) indicate that the UFOV is strongly related to passing an on-the-road driving evaluation, and that attentional measures like the UFOV are better predictors of driving performance in mild AD than the diagnosis itself. Project Leader: Linda Hunt, Washington University, St. Louis (314) 362-6911.
Alzheimer's Disease and Driving Performance. The UFOV is being evaluated as part of a larger study investigating the effects of Alzheimer's Disease and driving performance. The primary goal of the project is to develop fair and accurate criteria for determining whether older individuals, and especially those with AD, remain fit drivers. The effects of UFOV reduction on driving performance in the IDS are examined. UFOV loss correlated with an increased number of crashes in the IDS, resembling the relationship of UFOV loss to state reported crashes reported earlier in the literature. The AD drivers showed significantly greater reduction in the UFOV and significantly more crash involvement than an age-matched control group. Project Leader: Matthew Rizzo, University of Iowa (319) 356-8755.
Prospective Driving Study. This project involves a prospective
evaluation of risk factors for crash involvement among a community dwelling
sample of older drivers. To date, results show that only 26 percent of drivers
identified as high risk remain crash free for a period of three years, while 97
percent of low risk drivers remain crash free. Project Leaders: Karlene Ball
(205) 975-2290 and Cynthia Owsley (205) 325-8635.
Objective 2-Evaluation of the UFOV as a Behavioral Intervention
This objective is being pursued with different study populations and through collaborative activities as follows:
Subjects Referred for Driving Evaluation. This study involves a population referred by physicians to a driving evaluation program. Project Leaders: Karlene Ball (205) 975-2290 and Thomas Kadina, Bryn Mar. Rehabilitation (610) 251-5688.
Referrals from Insurance Records. This study involves a population recruited through insurance records. Project Leaders: Karlene Ball (205) 975-2290 and Christie Branch, Rehabilitation Institute of Chicago (312) 908-6277.
Volunteers from SBIR Project. This population consists of volunteers recruited through an SBIR Phase II project. During the first two years of the study, 456 older drivers were screened for attentional difficulties (UFOV reduction) and those with a restriction were recruited for a training study. Some participants received UFOV training, some received driver simulator training and others served as age-matched controls. In the first follow-up, the UFOV training was shown to transfer to improved stopping time in a driving simulator and had a significant reduction in hazardous driving maneuvers during an on-road driving evaluation (relative to the simulator and control group performance). At the 18-month follow-up, the training benefits had waned, but performance was still significantly better than pre-training levels. Anticipated completion date: August 1996. Project Leader: Daniel Roenker, Visual Resources, Inc.
Community-Based Volunteers. This population consists primarily of
volunteers recruited from the community. Project Leader: Linda Hunt, Washington
University, St. Louis (314) 362-6911.
VIII. Centers for Disease Control and Prevention(A8)
Health Status and Driving. The relationship between health status and driving is examined with data collected from an annual mail survey and from personal visits with residents in a California retirement community. Health indicators examined include medical condition, functional ability and use of medications. Indicators of driving patterns include crash frequency and driving limitation or cessation. Main reasons why older adults limit or stop driving and health measures that best predict driving status and ability are identified. Anticipated completion date: June 1996. Principal Investigator: Ann Dellinger, Centers for Disease Control and Prevention (770) 488-4811.
Health Status and Crash Risk. The 1995 Florida Behavioral Risk Factors Surveillance System, a statewide sample telephone survey, requested information on driving patterns from respondents aged 55 and above. These data will be combined with a database from California to more extensively examine the relation between medical conditions and crash risk. Comparability of the California cohort and the Florida sample will be established, and key characteristics associated with crash involvement will be identified, e.g., demographics, health status and medical conditions, safety belt use, alcohol use, miles driven. Anticipated completion date: October 1996. Principal Investigator: Ann Dellinger, Centers for Disease Control and Prevention (770) 488-4811.
Driver Capabilities and Vehicle Operation. The effect of driver capabilities on the safe operation of motor vehicles is examined. Psychophysical capabilities are assessed through a battery of tests designed specifically to tap capabilities shown to relate to age and highway crashes. Results are expected to help improve methods for detecting drivers with abilities that may be diminished by age and provide guidance in the formulation of licensing actions that optimally balance safety and mobility needs. Project findings also will have application in the development of valid tests to assess driving ability and driving safety. Anticipated completion date: Fall 1997. Principal Investigator: Jim McKnight, National Public Services Research Institute (301) 731-9891.
Benzodiazepine Use and Older Driver Crashes. The effects of benzodiazepines on crash involvement of older drivers are being assessed as part of a surveillance system being created to permit epidemiological studies examining the influences of prescribed medications on crash risk. The surveillance system could also have application for research on the efficacy of interventions to reduce high-risk medication use. Principal Investigator: Wayne Ray, Vanderbilt University (615) 322-2017.
Dementia and Driving Performance. The relations between driving ability, crashes, age and dementia are being examined. The performance of adults with Alzheimer's Disease is being evaluated on a driving simulator and on a battery of off-road behavioral tests and compared with actual road-test scores and state driving records. Neuropsychological and psychophysical measures that best discriminate between safe and unsafe drivers are identified. Results will be used to develop fair and accurate criteria for predicting driving ability in cognitively impaired populations. Principal Investigator: Matthew Rizzo, University of Iowa (319) 356-8755.
Longitudinal Analysis of High Risk Older Drivers. Data collected as part of an earlier study of the effectiveness of Medicare-reimbursed screening and health promotion services are being linked to North Carolina driver history data to explore the impact of medical conditions on driving safety. Anticipated completion date: Fall 1996. Principal Investigator: Jane Stutts, University of North Carolina (919) 962-2202.
Prospective Cohort Analysis of Health Status and Driving Risk. A
prospective cohort analysis is underway to assess the usefulness of certain
brief cognitive and visual screening assessments for identifying older drivers
at increased risk of crash involvement. Data were collected from 3,200 drivers
aged 65 and above applying for renewal of their North Carolina driver's license
from July 1994 through December 1995. Preliminary analyses show that the timed
road sign recognition test and Trails B performance are the measures most
strongly correlated with recent crash involvement. Later analyses will examine
the association of the various cognitive and visual function measures with
future crash involvement. Anticipated completion date: Fall 1996. Principal
Investigator: Jane Stutts, University of North Carolina (919) 962-2202.
VIII. National Institute on Alcohol Abuse and Alcoholism(A9)
Alcohol, Aging and Driving Performance. The interrelationships among aging, gender, alcohol use and driving performance are being investigated. The effects on driving performance of low levels of blood alcohol in combination with age, gender, driving complexity and sleep deprivation are being studied. In a secondary task, a modified Stroop test examines how alcohol may affect the performance of older drivers in intelligent transportation systems. Findings should be useful in counseling older persons regarding driving and alcohol use. Anticipated completion date: November 1998. Principal Investigator: Patricia F. Waller, University of Michigan (313) 764-6505.
IX. Selected Other Research Programs
Andrus Foundation
601 E Street NW
Washington, DC 20049
Contact: John Feather (202) 434-6200
The Andrus Foundation has a strategic planning process underway that will define new initiatives. Projects currently underway are described below.
Identify At-Risk Older Drivers. A screening instrument method for identifying at-risk older drivers is being developed. Previous work on cognition, vision and psychomotor function has been reviewed and is being incorporated as appropriate into the screening device. Anticipated completion date: Summer 1996. Principal Investigator: Rich Marottoli, Yale University (203) 785-3344.
Physician Assessment Tools. Simple tools are being identified for use in a physician's office to assess driving skills of older, functionally impaired individuals. Anticipated completion date: Summer 1996. Principal Investigators: Penny Keyl (410) 955-3479 and George Rebok, John Hopkins University.
The Safe Older Driver: Sensory and Medical Characteristics. A cross-sectional epidemiological study is being conducted to examine sensory and medical factors associated with safe and unsafe driving behavior among a random sample of community dwelling adults aged 55 plus in Marin County, California. Factors predicting subsequent safe driving are being defined and specific problem areas in mental and physical functioning as they relate to driving are being identified.
Preliminary data show that drivers who report that they self-restrict their driving vary from 40 percent of respondents aged 55-64 to as many as 73 percent of those 85 years plus. Almost one-third of all current drivers report they restrict their driving due to vision problems. Rarely are driving restrictions self-imposed due to problems with hearing, arthritis, balance and shortness of breath. It is expected that the sensory and medical characteristics found to be significant in this study can be quantified as part of a standard licensing protocol for older drivers. The results will also have application for the development of screening and training programs, graded licenses and street lighting and traffic signage standards. Anticipated completion date: Summer 1996. Principal Investigator: Catherine West, Buck Center for Research in Aging (415) 899-1800.
Predictors of Safe and Unsafe Driving in the Elderly. Visual, physical and mental function measures are identified that predict safe driving and adverse driving events when assessed over time. Using a prospective research design, this study will infer cause and effect and clarify the risk associated with sensory and medical characteristics. Data from an existing sample of older residents in Marin County, California, drawn in 1989, and a separate database that is currently being collected will be analyzed. Results are expected to be useful in developing improved clinical driver evaluations and standard licensing protocols for older drivers. Anticipated completion date: July 1997. Principal Investigator: Catherine West, Buck Center for Research in Aging (415) 899-1800.
Role of Cognitive Style in Driving. The role of cognitive style in
the driving skills of young, middle-aged and older adults are examined.
Relationships are assessed between field dependence-independence (cognitive
style), specific driving skills (sensitivity to bodily cues under skid
conditions, overcoming embeddedness in the perception of road signs and in the
recognition of developing hazards, defensive driving in high speed traffic) and
more general cognitive processes relevant to driving (e.g., reaction time,
selective attention). Age differences are examined in how cognitive style
functioning and driving skill relate over the course of adult development. The
feasibility of obtaining predictive measures of driving performance by the use
of computer-aided testing technology is explored. The findings have implications
for the most efficacious means of assessing driving behavior (self-reporting vs.
computer programs vs. actual road testing) and the design of training research
and programs for improving older driver skills. Anticipated completion date:
January 1997. Principal Investigators: Jack Demick (617) 573-829 and Debra
Harkins, Suffolk University.
AARP
601 E. Street NW
Washington, DC 20049
Contact: Katie Sloan (202) 434-6057
Alternative Transportation for Seniors: A Positive Option for
Families and Policy Makers.Jointly funded by AARP, FTA and NHTSA, this
five-month project explores the relation between the availability of alternative
transportation and driving cessation. Two specific questions are addressed: (1)
Does the existence of a private automobile-based transportation alternative
impact the decision of older drivers to stop driving?; and (2) Do older adults
who rely on family and friends for transportation feel they have adequate
mobility? Data are obtained from 90 structured, face-to-face interviews with
older drivers, former drivers and never drivers. Principal Investigator:
Katherine Freund (207) 828-8608.
AAA Foundation for Traffic Safety
1440 New York Avenue NW
Suite 201
Washington, DC 20005
Contact: Dave Willis (202) 638-5344
Older Driver Video. Production is underway on a video that encourages safe driving performance among older drivers and emphasizes the need to adjust driving patterns to current capabilities. Special attention is drawn to the interaction of alcohol and other drugs, and their effects on alertness. The video will provide an informative and up-to-date resource for use in driver improvement and refresher programs. Completed: Winter 1996, now available.
Public Service Announcements. A set of 30 second television PSAs are
being developed to promote older driver safety. The messages are being excerpted
from the older driver video that is currently in production. The PSAs will be
distributed throughout North America. Anticipated completion date: Winter
1996.
Alzheimer's Association of America
919 North Michigan Avenue
Suite 1000
Chicago, IL 60611
Contact: Catherine M. Ekstrom (312) 335-8700
Impact of Driving Cessation on Adults with Alzheimer's and Care
Givers. This pilot project assesses the psychosocial impact of driving cessation
on older adults with Alzheimer's and other dementias and their care givers.
Using motor vehicle records and community resources to identify research
participants, focus group and survey data are being collected to examine
behavioral antecedents and social and affective consequences of driving
cessation. The use of transportation services and the role and impact of family,
friends and others in driving and running errands for the "care recipient" are
examined. Findings will be used to design a larger scale study and will suggest
direction for needed transportation-related policies. Anticipated completion
date: March 1997. Principal Investigator: David Reuben, University of
California, Los Angeles (310) 825-8253.
California Department of Motor Vehicles
2415 1st Avenue
Sacramento, CA 95818
Contact: Ray Peck (916) 657-7031
Effects of Driving Restrictions and Driving Cessation on the Older
Adult. This project examines the effects of driving restrictions as an
alternative to license revocation when continued but limited driving is
appropriate, and the impact that driving cessation has on the self-esteem of
older adults. Also assessed is how family and friends are affected by the
driving cessation of their older relation. The Coopersmith Self-Esteem
Inventories and Rotter's Internal-External Locus of Control Scale are used.
Anticipated completion date: December 1996. Project Leader: Sandra Winter (408)
245-3609.
Ontario Ministry of Transportation
Safety Research Office
2nd Floor, West Building
1201 Wilson Ave.
Downsview, Ontario, M3M IJ8
Contact: Leo Tasca (416) 235-3623
Validation of the Senior Driver Research Inventory (SDRI). The SDRI was developed for the Ministry of Transportation of Ontario by Northport Associates. It currently consists of 62 self- reporting items which assess: (1) perception of functional deficits and the risks associated with them; (2) older driver willingness to acknowledge their functional deficits; and (3) compensatory tactics used by older drivers to minimize perceived risks and functional deficits.
Preliminary SDRI was pilot -tested. Three general scales (ability/risk, denial and compensation) were developed and subdivided into six sub-scales. Reliability coefficients calculated for each scale shows a moderate to high reliability. Scores on each SDRI sub-scale provide a measure of the subjects' ability to perceive functional deficits and associated driving risks, acknowledge their deficits and compensate for them.
SDRI scores of older drivers will be validated against their performance on the G2 road test, a valid and reliable road test developed as the advanced Level 2 exit test for Ontario's Graduated Licensing Program. Three hundred volunteers will complete the SDRI, a vision test and the G2 road test. Volunteers are aged 50 and above, and have at least 10 years driving experience but are not professional drivers. Anticipated completed date: December 1996. Principal Investigator: Jim Andersen, Engel, and Townsend (416) 235-3627.
1994 Exposure Survey. Trip patterns and crash exposure are examined for Ontario drivers. Data are collected year-round so that seasonal variations in driving patterns and risk can be identified. As part of the exposure survey, a three-day trip 109 was mailed to a random sample of 11,250 drivers aged 16 and above. The trip 109 requests information on the origin, destination, duration, length, purpose, and number of passengers. A small pilot test also was undertaken to evaluate an electronic vehicle device known as the Autologger. Recent developments in computer software and hardware have made it worthwhile to examine the feasibility of in-vehicle data collection. Anticipated completion date: Summer 1996. Contractor: Human Factors North.
Analysis of the Useful Field of View. This study aims to develop a diagnostic benchmark for UFOV scores by estimating the range of UFOVs found in health individuals aged 16-85. Subjects will be screened for ocular diseases and/or brain damage. Anticipated completion date: Summer 1996. Contractor: University of Toronto.
Medical Fitness and Crash Risk. This project has four objectives: (1) survey selected jurisdictions in North America and Europe and compare the organization, content and function of their medical review programs; (2) review program evaluation studies in these jurisdictions; (3) review landmark legal decisions or impending court challenges in these jurisdictions related to physician reporting requirements; and (4) review the literature on driving performance and medical fitness relating to monocular vision; restricted visual field disorders (e.g., hernianopia and quandrantopia); seizure disorders, diabetes; prescription drug side effects of narcotic analgesics, anxiolytics and antidepressants, sleep disorders; and organic brain damage due to head injury. Anticipated completion date; Summer 1996. Contractor: Human Factors North.
Crash Involvement and Injury Outcomes by Age and Gender. The Ontario
Ministry of Transportation is developing a detailed statistical profile of all
crash-involved drivers from 1992-1994. The study focuses on three older age
categories: 60-69, 70-79 and 80 and above. Crash involvement frequencies and
patterns for these age categories and patterns for these age categories are
compared to each other and to drivers aged 16-19, 20-24, 25-44 and 45-59. Each
age category is also subdivided by gender. Other key explanatory variables
include pre-crash driver action, pre-crash vehicle maneuver, initial impact,
location and environmental conditions. Dependent variables include crash
frequencies, crash patterns and injury outcomes (injury/property damage only).
Anticipated completion date. Summer 1996. Contractor: Ontario Ministry of
Transportation.
Alberta Mental Health Research Fund
Alberta Heritage Fund for Medical Research
3125 Manulife Place
Edmonton, Alberta T5J 3S4
Contact: Lois Hammond (403) 423-5727
Driving and Dementia: Consequences of Evaluation and De-licensing. This study investigates the consequences that a driving evaluation and resulting recommendations about continued driving have for adults with dementia and their caregivers. Subjects include dementia patients who are participating in an ongoing research project that evaluates driving fitness and who have been referred to a driving evaluation by a physician. In cases where driving cessation is considered necessary, structured interviews are used to assess the psychosocial (e.g., psychological reaction, change in independence, social interactions) and financial impacts that the loss of driving privileges have for patients and caretakers. Patient reactions to the physician, the consequences for the patient-client relationship, the patient's compliance to the recommendation, and the role of the family in obtaining compliance are also addressed. For those who retained driving privileges, the emphasis is on documenting continued driving activities and reported difficulties, and changes in mobility and family relationships. The information obtained from the project will provide a basis for developing follow-up research and outreach programs.
Estimates indicate that 25-30% of dementia patients hold a valid
driver's license and are currently driving at the time of diagnosis. Because
dementia signifies a general loss of cognitive abilities, there is a question
about the person's competence to drive. In the case of progressive dementias,
such as Alzheimer's Disease, there will always be a point for which cessation of
driving is necessary. This study will help us better understand the impact this
transition has on these patients and their caregivers. Principal Investigator:
Allen Dobbs, University of Alberta (403) 474-8840.
APPENDIX B: The Aging Process and Physiological
Functioning
I. Summary of Age-Related Deficits Relevant to Vehicle Operation
SENSORY FUNCTIONING
Vision
- reduced visual acuity at far distances
- less able to focus on near objects
- more likely to have cataracts, glaucoma, macular degeneration, especially after the age of 85
- require greater levels of illumination
- more sensitive to glare
- impairment of night vision
- peripheral visual field drops from 170 degrees in the young adult to 140 by age 50
- static visual acuity starts to decline slowly around age 50 and then more rapidly
- response to visual stimuli is slowed due to reduced acuity and
sensitivity to contrast
Hearing
- less able to hear low and high frequency tones
- less able to differentiate between tones
- less able to block out background noise
COGNITIVE FUNCTIONING
Perception
- increased difficulty in ignoring irrelevant stimuli
- slower retrieval and processing of information
- spatial orientation and visual-motor integration abilities diminish
with age
Memory and Learning
- after the age of 75, the learning rate diminishes to half that of a 20 year-old
- the age differences in learning ability until age 75 are small
- reduction in short-term memory
Attention
- ability to divide attention diminishes
- searching and scanning abilities, which require selective
attention, diminish
Intelligence
- the level of general intellectual functioning is maintained into normal old age
(lower scores on standard IQ tests)
- differences are more pronounced on tests of fluid intelligence, which measure ability to think and reason abstractly, than those of crystallized intelligence, which measure the ability to learn from experiences
- differences are more pronounced on tests of nonverbal abilities than those of verbal skills which are maintained until about age 70 and then decline only gradually
- the prevalence of significant cognitive impairment for non-institutionalized persons: aged
65-74 3%
75-84 14%
over 85 20%
PSYCHOMOTOR and PHYSICAL FUNCTIONING
Reaction Time
- general psychomotor slowing most likely due to slower peripheral and central processing
- take longer to perform tasks
- reduced speed of motion inverse to the complexity of the movement required
- slightly slower simple reaction time
- the more complex the stimulus display and the decision to be made, the greater the difference in reaction time between the young and old
- the elderly often substitute accuracy and consistency for speed of
response
Strength and work capacity
- reduced handgrip, shoulder and back strength
- reduced capacity for continued exertion
- limitations of motor activity
- work capacity of 70 year- old equal to half that of 20 year-old
- small but gradual decrease in muscle strength until age 60, then the decrements become more dramatic
- losses are greater in women, greater in the lower than the upper extremities and greater in fast versus slow velocity movements
- most loss of strength up to the age of 70 is due to disuse
OTHER PHYSIOLOGICAL AND AGE-RELATED CHANGES
Body Conformation and Composition
- diminution of stature
- posture less likely to be erect
- weight loss begins between 50 and 70, stabilizes in women
- brain weight declines
- heart weight does not decrease, and actually increases relative to total body weight
- overall decrease in bone mass starting in the 20s
- increase in fat deposition until age 50 then decreases thereafter
- increase in body mass even though weight stabilizes or decreases
- total body water decreases resulting in problems stabilizing body
temperature
Tissues and Organ Systems
- elevation in blood pressure
- increased incidence of arthritis and rheumatism
- onset of osteoporosis and osteoarthritis
- reduction in muscle mass as great as 30 percent between 30 and 80 years of age
- the reduction in muscle mass accounts for much of the loss of
strength
Respiratory and Cardiovascular Systems
- reserve resources available for coping with activity or challenge above that of the basal or resting state are globally reduced with aging
- functions at rest are adequate
- more likely to have chronic respiratory problems
- total lung capacity is reduced (however, when controlled for height, total lung capacity may be independent of age)
- more likely to have cardiovascular disease
- increase in atherosclerosis
- decline in maximal heart rate, maximal exercise capacity, increase
in systolic blood pressure, left ventricle wall thickness, deterioration of
glucose and lipid metabolism. Rate of loss of cardiac output is equal to 1
percent per year starting in the 30s
ADDITIONAL DISCUSSION
The Aging Process and Physiological Functioning
There are a number of specific age-related physiological changes that occur with normal aging. Vision, in terms of functionality, is one of the most important sensory modalities. Visual changes characteristic of the aging process include:
- lower visual acuity at far distances and less ability to focus on near objects, static visual acuity starts to decline slowly around age 50 and then more rapidly
- increased likelihood of cataracts, glaucoma, macular degeneration, especially after the age of 85
- impairment of night vision due to requirements for greater levels of illumination, increased sensitivity to glare and slower accommodation
- reduced peripheral visual field, (from 170 degrees in the young
adult to 140 by age 50)
Another critical sensory modality is hearing. The aging process often results in:
- decreased ability to hear very low and very high frequency tones and to differentiate between tones
- decreased ability to block out background noise
Cognitive functioning including attention, memory, and learning is
also negatively impacted by the aging process resulting in:
- increased difficulty in ignoring irrelevant stimuli
- slower retrieval and processing of information
- diminished spatial orientation and visual-motor integration
- diminished learning rates. After the age of 75 it is half that of a 20 year old (however reductions in learning ability until age 75 are small)
- reduction in ability to 'time share' or divide attention among two or more tasks
- diminution in searching and scanning abilities which require selective attention
Intelligence which is an index of cognitive functioning, shows some decrease with age. However, the decrease may have been overestimated in the past. This overestimation results from using a cross sectional methodology. This methodology involves comparing different individuals with different ages. A more appropriate methodology (longitudinal) involves gathering data for the same individuals as they age. The outcomes of longitudinal studies suggest that the level of general intellectual functioning is maintained well into old age. Use of longitudinal comparisons correct for educational opportunities and other experiential considerations. For example, as a group, individuals born in 1916 are likely to have had less education than a socio-economically similar individual born in 1966. Such artifacts appear to explain findings involving weaker scores on standard IQ tests.
However, there are age-related differences in measured intelligence. For example, differences were more pronounced on tests of fluid intelligence, which measure ability to think and reason abstractly, than those of crystallized intelligence, which measure the ability to learn from experience. Also, reductions in scores on tests of nonverbal abilities are larger than those of verbal skills. Verbal skills are maintained until about age 70 and decline only gradually. In general, the prevalence of significant cognitive impairment for non-institutionalized persons aged 65-74 is about 3 percent, by 75-84 it is 14 percent, and over 85 it is greater than 20 percent.
Psychomotor and physical functioning are critical factors in vehicle operation. One important area is reaction time. Aging results in a general psychomotor slowing, most likely due to slower peripheral and central processing. Simple reaction time is only slightly slowed by the aging process, but it takes longer to perform more complex tasks. There is a reduction in the speed of motion which is inverse to the complexity of the movement required. The more complex the stimulus display and the decision to be made, the greater the difference in reaction time between the young and old. Older operators often compensate by substituting accuracy and consistency for speed of response.
There is a small but gradual decrease in muscle strength until age 60, then the decrements become more dramatic. The work capacity of a 70 year-old is equal to half that of a 20 year-old. Finally most loss of strength up to the age of 70 is due to disuse.
Strength and work capacity are diminished due to:
- reduced handgrip, shoulder and back strength
- reduced capacity for continued exertion
- limitations of motor activity
- The losses are greater in women, greater in the lower than the
upper extremities, and greater in fast versus slow velocity movements.
There are a number of other age-related physical and physiological
changes:
Body conformation and composition
- diminution of stature
- less erect posture
- overall decrease in bone mass starting in the 20s
- weight loss beginning between 50 and 70, (stabilizes in women)
- decline in brain weight
- heart weight increases relative to total body weight
- increase in fat deposition until age 50 then decreases thereafter
- increase in body mass even though weight stabilizes or decreases
- total body water decreases result in increased difficulty in
stabilizing body temperature
Tissues and Organ Systems
- increase in blood pressure
- more likely to suffer arthritis and rheumatism
- onset of osteoporosis and osteoarthritis
- reduction in muscle mass as great as 30 percent between 30 and 80
years of age
Respiratory and Cardiovascular Systems
The reserve of function available for coping with activity or challenge above that of the basal or resting state is globally reduced with aging. However, functions at rest are usually adequate. Older adults are:
- more likely to have chronic respiratory problems
- more likely to have cardiovascular disease
- reduced cardiac output, the rate of loss is equal to 1 percent per
year starting in the 30s
II. Discussion of Impairing Conditions
Dementias
Dementia is characterized by the loss of cognitive abilities such as memory, perception, verbal ability, and judgment. In most instances, losses are permanent and progressive resulting in total incapacitation and even death. Although there are more than 60 forms of dementia, Alzheimers' disease is the most prevalent, accounting for more than half of all cases of dementia. Estimates of the prevalence of Alzheimers' disease range from about 10 percent of all those over 65 years of age to almost 50 percent of those over 85 years of age. Other types of dementia include vascular dementias (such as multiple infarct dementia), Pick's disease, Parkinson's disease, Huntington's disease, progressive supranuclear palsy, AIDS, brain trauma, anoxia, and metabolic or toxic disorders.
Various studies have reported that 2.6 to 15.4 percent of those over 65 years of age suffer from some type of mild to moderate dementia. Severe dementia is characterized by gross functional loss and total dependency. Therefore, only those with mild to moderate dementia are likely to still be operating vehicles. Early symptoms of dementia include memory loss, disorientation and impaired judgment. Overlearned activities such as those used in driving may be spared, for a time, but responses requiring judgment, such as those presented by an obstacle or hazard, are typically impaired early in the progressive course of disease. Visual abilities impaired by dementia of the Alzheimer type including tracking performance, field deficits, and retinal degeneration causing impairment of contrast sensitivity, depth perception, motion and orientation.
Parkinson's and other subcortical dementias involve both mental and neuromuscular deficits. Mental deficits are usually mild to moderate in severity and include mental slowness, lack of initiative, forgetfulness, cognitive impairment and mood disturbance. Physical deficits include slowness of movement, rigidity, and tremor. Approximately 25 percent of those with Parkinson's disease will develop symptoms of dementia in addition to neuromuscular deficits. Pharmaceutical treatment may improve symptoms but merely postpone the incapacitating and progressive effects of the disease.
Vascular dementias are caused by multiple vessel occlusions which result in a lack of blood to a specific area of the brain and present with abrupt onset and stepwise rather than continuous deterioration. Symptoms include both those of cortical dementias, such as Alzheimer's, and subcortical dementias, such as Parkinson's. Vascular dementias are not treatable but the state of impairment can be stabilized if the underlying cause of occlusions is treated.
Pseudodementias such as depression can cause slowness of response, forgetfulness, disorientation, attention deficit, psychomotor slowing, and impaired effortful processing. Unlike true dementias, depression can be completely reversible. Pseudodementia may account for as much as 30 percent of dementia diagnoses.
Dementias affect ability to operate a vehicle in the critical
functions of perception, selective attention, divided attention, judgment and
impulse control. Unsafe driving in persons with dementia has been attributed to
declines in attention and visuospatial skills. However, as many dementias are of
gradual onset and progressive in nature the mere diagnosis of dementia is
insufficient to determine the functional ability of the afflicted.
Cardiovascular Conditions
Cardiovascular conditions include coronary heart disease, angina pectoris, myocardial infarction, cardiac failure, cardiac arrhythmias, cardiac effects of pulmonary disease and hypertension. The primary aspects of cardiovascular disease that may impair ability to operate a vehicle include sudden loss of consciousness, and the symptoms of pain, dizziness and blurred vision brought on by myocardial infarction. Insufficient oxygen supply to the brain may cause impaired cognition in some heart conditions, and sudden death at the wheel may also occur.
The symptoms of congestive heart failure include weakness, fatigue,
confusion, and impaired alertness and stamina. It has been estimated that
approximately 30 percent of those over 65 have some form of cardiovascular
disease. The risk of cardiac failure increases a hundredfold from 35 to 65 years
of age. The incidence of heart failure for men aged 65-74 is 8.2 per 1,000 (four
times the rate of those aged 45-54), rising to 13 per 1,000 for those 75-84
years of age, and 50 per 1,000 for those 85-94 years of age. An increased
societal risk posed by those who drive with known cardiovascular disease cannot
be determined from a review of the literature.
Cerebrovascular Conditions
Cerebrovascular accident (CVA) or stroke has a sudden onset and is caused by interrupted flow of blood to part of the brain, an aneurysm of the wall of a blood vessel, or rupture in the wall of a blood vessel. The likelihood of stroke increases with age and is about 1 percent per year for those aged 65-74. Resulting disabilities may include musculoskeletal impairments, sensory damage, perceptual and cognitive problems, and behavioral or emotional problems. The type of symptoms suffered depend on the part of the brain affected and the extent of damage. Transient ischemic attacks (TIAs) are by nature short-lived with supposedly no residual impairment but can result in temporary monocular blindness, weakness in one side of the body, language deficit, confusion and limited voluntary movement.
Residual deficits that have shown to significantly impair driving
ability among CVA patients include problems in spatial perception, visual
scanning and other visual problems, poor tracking ability, slowness of response,
and confusion when situations require complex actions. These deficits result in
an inability to perceive hazards, drifting sideways while driving, lack of
caution, and inattentiveness to signs and traffic conditions. Although many CVA
patients successfully compensate for deficits by restricting their driving or
modifying their driving style, this requires an awareness of deficits and
self-critical abilities which may be dysfunctional.
Diabetes Mellitus
The prevalence of Type II diabetes, Non-Insulin Dependent Diabetes
Mellitus (NIDDM), a disturbance of glucose metabolism that can be controlled
through the use of hypoglycemic agents and prescribed diet, increases after the
age of 45, reaching approximately 8.8 percent of those aged 65-74. Ninety
percent of the population with diabetes, and most elderly diabetics, have the
NIDDM type which is characterized by the increased likelihood of comorbidities
such as cardiovascular disease, cerebrovascular disease, diabetic neuropathy,
cataracts and diabetic retinopathy. Poor diabetic control can result in slowed
attention, fine motor skills and response time, fatigue, lethargy and
sluggishness and studies have shown that older persons with NIDDM have impaired
short-term memory. The bulk of the literature reflects some increased risk for
drivers with diabetes due to the cognitive impairments caused by hypoglycemia,
however, this increased risk appears to be independent of age. Diabetic
neuropathy may prevent older diabetics from detecting symptoms of hypoglycemia
leading to possible loss of consciousness, convulsions or coma.
Epilepsy
Epileptic seizures are characterized by a loss or altered state of
consciousness. Symptoms range from dizziness or clouded thought processes to
disorientation, confusion, bizarre behavior, and altered visual and auditory
experiences to total loss of consciousness. The anticonvulsant medications that
can control seizures can also adversely affect one's state of consciousness.
Those with uncontrolled seizures do not qualify for an operator's license due to
the high likelihood of recurrent seizures. However, approximately 70 percent of
those with epilepsy achieve remission with proper treatment. The increased risk
to older drivers with epilepsy appears to be not significantly different from
other drivers over 25 years of age.
Ocular System Disease
Normal visual deficits and those attributable to subclinical
pathology become difficult to delineate as individuals age. A dramatic decline
in visual acuity that begins at age 60 or 70 can be attributed to cataracts,
senile macular degeneration, diabetic retinopathy and glaucoma. It has been
estimated that 19 percent of those aged 65 to 75, and 50 percent of those over
75 have at least one of these conditions. These conditions result in reduced
contrast sensitivity and insensitivity to glare. Cataracts tend to reflect back
light and scatter it reducing the light that reaches the retina and increasing
glare. The prevalence rate of cataract and macular degeneration increases
tenfold from under age 65 to over age 75, with over 40 percent of those over age
80 having cataracts. Glaucoma, which diminishes peripheral vision and can cause
blindness affects 3 percent to 5 percent of those over 65 years of age and is
twice as common in those over age 75 as those under age 65. Senile macular
degeneration, in which the central area of the retina degenerates, affects 1
percent to 3 percent of those over 65 but is the leading cause of blindness in
the elderly. The most successfully treated ocular diseases are cataracts which
can be surgically curable. However, cataracts must progress to opacity before
they can be removed therefore continuing to present a functional deficit until
that point. Studies have shown that drivers with visual field loss due to
glaucoma, retinal disorders and cataracts have an increased risk for motor
vehicle accidents twice that of non-visually impaired drivers.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is characterized by a decline in lung function caused by limited
oxygenation of the blood and accounts for a decrease in the maximum aerobic work
a person is capable of. Although air flow abnormalities begin around age 40,
dyspnea does not become pronounced until between age 50 and 70. The common
symptoms are weakness and fatigue requiring oxygen therapy to allow exertion,
diminished judgment and concentration, cough syncope in severe cases, and
pulmonary hypertension and ultimately heart failure. In one study, 13 percent of
men and 4 percent of women had COPD.
Arthritis
There is a dramatic increase in the prevalence of osteoarthritis
after the age of 50 reaching 50 percent of those over 65 years of age with
arthritis in at least one joint. The activities of approximately five million
older persons are limited because of arthritis. The presence of arthritis causes
pain and restricts mobility, range of motion, and strength. Although
arthritis-related disabilities are less severe than those of many other chronic
conditions, when arthritis coexists with other chronic conditions, the
disabilities are exacerbated. The absolute restriction of range of motion,
decreased grip strength, decreased head and neck mobility, and hip and leg
motion limitations can interfere with an arthritic's ability to safely operate a
vehicle. The pain of arthritis also produces involuntary hesitation which can
compromise safe operation of a vehicle. The psychology of immobility also can
prevent a person with arthritis from relinquishing activities that may further
restrict mobility such as driving.
Medications and Polypharmacy
Medication use increases with age. Studies suggest that at least three quarters of those over 65 use prescription medications and the Medicare population takes on average ten drugs a day. Polypharmacy refers to the situation in which multiple medications are taken, possibly with interacting effects. The combined influences of severe illness, comorbidities and multiple medications are more indicative of adverse reactions than age per se; however, the likelihood of these combined influences increases with age. The likelihood of adverse drug reactions dramatically increases with age as well, with an incidence among those aged 65 or older three to seven times that of young adults. Older people are more sensitive to medications than younger adults. Reduced hepatic and renal function and altered body composition diminish the capacity for medication excretion in older individuals.
Depressants such as benzodiazapines (prescribed for anxiety and
insomnia), antipsychotic drugs (major tranquilizers) and antihistamines can
impair cognitive and psychomotor functioning due to their sedating effect.
Clinically significant drowsiness attributable to benzodiazapines appears to be
two to three times more likely to occur in older adults than younger adults.
Tricyclics prescribed for depression have been shown to decrease functioning in
the older adult due to a sedating effect as well. Hypoglycemics taken for
diabetes mellitus and opioid analgesics also have been shown to adversely affect
cognitive and psychomotor functioning. Although not a large percentage of those
over 65 abuse alcohol, they are particularly susceptible to interactions between
medications and even small amounts of alcohol. Alcohol has a pronounced effect
on motor skills when taken in conjunction with psychotropic medications. Alcohol
also increases the depressant effect of tricyclic antidepressants,
benzodiazepines and antihistamines in the elderly. Although recommendations have
been made for the elderly driver to avoid alcohol, narcotics, hypnotics,
anxiolytics, barbiturates, analgesics, antipsychotics, antihypertensives,
skeletal muscle relaxants, ophthalmic agents and antihistamines, this is highly
problematic considering the high necessity for and prevalence of these
medications and the lack of epidemiological confirmation that specific
medications increase risk.
III. Selected Excerpts from Draft White Paper for Medical Research and Practices Expert Panel, March 21-22, 1996
(For discussion purposes only, do not cite or
quote)
A. Introduction
On December 4, 1995, Secretary Peña instructed:
"The DOT should be constantly proactive regarding emerging safety and service problems in the Nation's transportation system. One problem demanding such attention is the ongoing demographic shift in the age of those who operate in our system...We need to investigate the special needs of these operators and develop responses...
By anticipating emerging service and accessibility problems in the nation's transportation system, DOT's strategic planning will develop comprehensive, cross-modal strategies to stay ahead of societal changes and to build accommodation into the system.
Increased longevity and the maturing of the "baby boom bulge" are likely to raise two transportation issues:
DOT needs to obtain information about aging vehicle operators, both commercial and noncommercial. This information can be used to develop strategies to help experienced commercial operators to maintain their proficiency and independence further into maturity, to safely extend the mobility of aging Americans as private operators and to ensure continued mobility and accessibility for aging vehicle operators.
DOT has initiated Improving Transportation in a Maturing Society (ITMS) to determine the impact that postponed retirements, longer productive lives and the growing segment of older operators will have on the Nation's transportation system. While ITMS expresses an encompassing issue, for the purposes of addressing it, ITMS has five components:
Aging Scenarios
Medical Research and Practices
Management Practices
Human Factors and Technology
Alternatives for Meeting Personalized Mobility Needs
The main source of information for this departmental initiative will come from the results of the invitation-only Expert Panels, each of which is addressing one of five components cited. When compiled, the DOT will use the results of these panels to define how best to maintain the proficiency of and to accommodate the anticipated increasing numbers of older operators.
Participants in the second of this series of Expert Panels, Medical
Research and Practices, to be held in Chicago on March 21-22, 1996, will discuss
and report on the medical aspects of the aging operator in each mode of
transportation, including those specific to commercial and private operators.
This White Paper puts forward the background issues for this Medical Research
and Practices Expert Panel. Section II provides the context in which the
pertinent medical issues will be discussed. Section III discusses the
age-related physiological changes that occur with normal aging. Section IV lists
the current medical requirements for both commercial and recreational operators.
Section V summarizes the medical conditions that could potentially impair the
aging vehicle operator. Section VI discusses evaluation and assessment of
medical conditions in older operators. Section VII discusses medical
interventions for the older operator. Finally, Section VIII discusses the role
of the medical community vis-a-vis the older operator.
B. Issues Related to Age and the Ability to Operate Vehicles and Enjoy Transportation Services
Because DOT is responsible for ensuring safety in transportation and meeting the need for mobility in a population with an increasingly greater propensity for mobility, Secretary Peña has noted:
" there is an ongoing demographic shift in the age of those who operate our transportation system. The aging work force of aircrews, commercial vehicle operators, rail crews and mariners are likely to seek to work longer and to postpone retirement. Similarly there will be increasing numbers of aging private motorists and recreational boaters and pilots. We need to investigate the special needs of these operators..."
The issues of aging vehicle operators concerns the DOT at this time
for many reasons including; the increased number of people over age 65 and the
growing relative proportion of people in these age categories, the movement to
postpone retirement due to the economics of retirement, advances in health care
and changes in life styles with the movement to the suburbs.
Transportation involves people as both operators or passengers. Regulation and custom have defined the point at which people are sufficiently mature to operate the various transportation modes by means of licensing and certification procedures. As transportation technologies have developed, the definitions of maturity required for operation have been refined. However, as the number of operators in the older segment of the population has expanded, questions have arisen whether these older workers retain the requisite abilities to operate the transportation systems safely. Further, U.S. society relies to a very large extent on personal transportation, particularly the automobile. Age related restrictions in the ability to operate personal vehicles due to reduced capacities isolates large segments of our population from participating in society.
Older people are both producers and consumers of transportation. Obviously, such activity is socially and economically beneficial. Mobility and productive work are to be encouraged. However, there is a sense that aging somehow can interfere. There is a need for consensus on what aging means in terms of ability to operate commercial and private transportation vehicles and to enjoy the benefits of various transportation modes, including walking.
While age refers to the length of time during which a person has lived and the periods or stages of life, there is a specific chronology which defines when people are recognized as mature and attain specific legal rights and responsibilities.
Few such chronologies have been established for relinquishing rights and responsibilities for the older segment of the population. While all people will show the effects of aging or undergo change and a diminution of essential qualities with the passage of time, there are large individual difference in the effects and impacts of the aging process. The problem is how to recognize and deal with these differences while maintaining both safety and social mobility.
In a gerontological sense, 'age' connotes a host of physical,
psychological, cognitive, and socioeconomic changes. Sensory functions,
perceptual processes, decision making, and psychomotor performance decline,
sometimes, predictably. Yet the decline is not constant for any one individual.
In fact, differences among individuals widen as age increases. This makes
analysis and policy making on aging difficult. Even if age changes were
precisely identified, the impact on transportation would not always be clear.
Humans compensate for deficits, finding alternative ways to do activities.
C. The Age-Related Physiological Changes that Occur with Normal
Aging
General Considerations
Aging vs. Disease
The universal consequence of the aging process on the human body is the decreased efficiency and ability of the body under increased demand to maintain functional levels within normal limits and the slowed rate of return to normal levels once systems are stressed. Conduction velocity of nerves, cardiac output, renal function and respiratory function are all less capable of withstanding stress in older individuals.
The normal process of aging is associated with increased incidence
and severity of diseases. This increased and often multiple pathology co-occurs
with reduced homeostatic sufficiency. Aging, therefore, becomes the succession
of events that accumulate and increase the probability and onset of functional
failure and disease. Differentiating between disease processes and those gradual
degenerative changes that develop over the passage of time is often difficult if
not impossible. Additionally, as the prevalence of chronic disease increases
with age, it becomes more difficult to differentiate between functional loss due
to the effects of disease versus that concomitant with the aging process.
The Heterogeneity of the Aging Process
The aging process involves complex interactions of genetic and environmental influences. Therefore, there exists a lack of uniformity of age-related changes between individuals and within the same individual. The onset, rate and degree of changes vary depending on the organ, system, or function in question.
It is important to consider the compensatory responses that can
counteract losses due to the normal process of aging and the potential for
rehabilitation to make up for functional losses. Also, the heterogeneity between
individuals increases with age, both in terms of decrements and compensatory
ability. While a single impairment might be compensated for with relative ease,
multiple impairments are more difficult to overcome. This extreme heterogeneity
of functional status strongly supports the view that the elderly be evaluated on
an individual basis, especially as health and fitness status, and social,
economic and environmental conditions continue to impact how Americans age.
The Aging Process and Physiological Functioning
Older people, on average, do not perform as well as younger adults on
almost all available measures of physiological functioning. However, in many
cases, these deficiencies are small and the range of measured responses often
overlap, with some older individuals functioning better than their younger
counterparts. Therefore, these average measures can not predict individual
performance. Certain generalities can be made however regarding the physiology
and functioning of older persons in comparison to younger adults.
SENSORY FUNCTIONING ........................................................... (See Appendix B-I, above)
PSYCHOMOTOR and PHYSICAL FUNCTIONING ...................... (See Appendix B-I, above)
OTHER PHYSIOLOGICAL AND AGE-RELATED CHANGES .... (See Appendix B-I,
above)
D. DISEASES OF THE ELDERLY
Limited to Aging
Osteoporosis
Osteoarthritis
Prostatic Adenocarcinoma
Polymyaglia rheumatica
Temporal arteritis
Associated with Aging
Myocardial infarction
cerebrovascular disease
nephritis
cirrhosis
pneumonia
septicemia
NIDDM
Neoplasm
Hypertension
Alzheimer's disease
Parkinson's disease
Emphysema
E. MEDICAL CONDITIONS THAT MAY INCREASE DRIVING RISK
Disease and Disorders Common in Age-Related Physiologic Changes Older Persons
Decreased vision Cardiovascular and pulmonary diseases
Decrease static visual acuity Ischemic heart disease
Decrease dynamic visual acuity Arrythmias
Decreased temporal fields Sleep apnea
Decreased resistance to glare Chronic lung disease with hypoxia
Decreased low luminescence vision Diabetes mellitus
Decreased reaction time Neurologic diseases
Hearing loss Alzheimer's disease and cognitive impairment
Parkinson's disease
Stoke
Neuropathies
Seizures
Polypharmacy
Arthritis
Alcohol Use
Adapted from Reuben, DB (1993). Assessment of Older Drivers. Clinics in Geriatric Medicine, 9(2), pp 449-459.
Percentage of Persons Aged 65 and Older with Functional
Impairments
Function Men(%) Women(%)
Visual impairment 8.60 6.38
Color blindness 2.38 non-estimable
Cataracts 9.80 19.38
Glaucoma 5.37 4.91
Hearing impairment 39.55 26.91
Tinnitus 9.81 8.79
Mobility impairment 4.23 8.52
Self-care limitation 6.94 8.07
Colsher, PL and Wallace RB (1993). Geriatric Assessment and Driving
Functioning. Clinics in Geriatric Medicine, 9(2), pp. 365-375.
Skills Needed for Driving Capably
Sensory Function
Vision
Static visual acuity
Peripheral vision
Depth perception
Color vision
Dynamic visual acuity
Night vision
Glare recovery
Ability to change focus from near to far
Entire visual field
Hearing
Cognitive Functioning
Memory
Attention
Visuospatial skills such as systematic scanning of environment, judging distances and speeds, locating and using controls appropriately
Verbal and information processing
Decision making and problem solving
Psychomotor Functioning
Muscle strength
Range of motion
Grip strength
Reaction time
Colsher, PL and Wallace RB (1993). Geriatric Assessment and Driving
Functioning. Clinics in Geriatric Medicine, 9(2), pp. 365-375.
Characteristics Related to Age and Driving Ability
Sensory Cognitive
Static Visual Acuity Information Processing Rate
Dynamic Visual Acuity Short Term Memory
Low Illumination Acuity Long Term Memory
Low Contract Acuity Decision making-time-distance judgment
Contrast Sensitivity
Dark Focus Accommodation Psychomotor
Glare Resistance Simple Reaction Time
Glare Recovery Choice Reaction Time
Visual Field Tracking
Color Vision
Hearing Consciousness
Level of Arousal
Attentional
General Attention Level Physical
Attention Switching Coordination
Attention Sharing Range of Motion
Selective Attention Strength of Motion
Smoothness of Motion
Perceptual
Form Identification
Form Recognition
Field Dependence
Visual Search Effectiveness
F. Issues for the Medical Research and Practices Panel to
consider:
1. What affect does the normal aging process have on the physical and psychological functioning of individuals?
2. Specifically, what deficits can be expected in relation to the young adult?
Sensory
Psychomotor
Cognitive
Other
3. How does the aging process affect an individual's ability to operate a vehicle safely?
Sensory
Psychomotor
Cognitive
Other
4. What compensatory responses do older people employ to make up for the expected losses due to aging?
5. Are future cohorts of Americans expected to age differently than those who are elderly today?
6. How will these differences affect the safe operation of transportation systems?
7. What are the current medical requirements for commercial operators in the different modes of transportation?
8. What are the medical requirements for private or recreational operators (pilots, boaters, automobile drivers)?
9. What are the reporting requirements for medical professionals regarding the impairments of their patients that might pose a threat to themselves or the public?
10. What diseases are limited to the aging?
11. What diseases are associated with aging?
12. What impact does the presence of certain diseases or conditions
have on the normal aging process?
13. What impact does the presence of certain diseases or conditions have on the ability of an older individual to operate a vehicle safely?
14. Has a relationship been made between the presence of certain diseases or conditions and the accident rate of various types of vehicle operators?
15. Does the presence of diseases or conditions affect operators of various types of vehicles differently?
16. Would the risk posed to the operator or the public by a certain disease or condition vary based on the type of vehicle?
17. Does the presence of certain diseases or conditions impact the older operator differently than the younger operator?
18. What evaluation and assessment techniques are appropriate to measure the impact of the aging process on an individual's ability to safely operate a vehicle?
19. Should the utilization of evaluation and assessment techniques vary depending on the presence of certain diseases or conditions?
20. What evaluation and assessment techniques are currently utilized to assess the ability of older vehicle operators?
21. What, if any, restrictions should be placed on vehicle operation based on the results of evaluation and/or assessment?
22. What medical interventions may ameliorate or lessen the impact of certain disease or medical conditions on the older operator?
23. What medical interventions are effective in assisting the older operator with limiting disease or medical conditions to function safely?
24. What role does the medical community have in transportation issues?
25. What role does the medical community have in evaluating the ability of older persons to operate vehicles?
26. What role does the medical community have in assisting older operators to maintain their mobility through the transportation system?
27. What role does the medical community have in reporting individuals who may pose a threat to themselves or the public due to impaired ability to operate a vehicle safely?
28. What requirements should be in force for the medical community
regarding the reporting or monitoring of potentially unsafe vehicle operators?
I. Proposed Human Factors Handbook
The FHWA Human Factors Team is recommending the development of a Strategy to Market the highway safety applications and findings derived from the Improved Highway Travel for an Aging Population High Priority Area of research. This program is in its middle stages and results from a number of studies are becoming available that will soon be compiled in the "Preliminary Human Factors Older Driver and Highway Safety Handbook."Based on these guidelines, the FHWA Human Factors Team will develop a set of highway design applications geared to improve the driving performance of older drivers. A blueprint of these applications will be presented to communities for implementation with the goal of demonstrating their effectiveness through an increase in older driver safety and mobility. Long-term objectives include the implementation of these applications to a greater number of communities as their success is documented.
It has been determined that many of the emerging ITS innovations will
present opportunities for increased mobility and safety for older operators.
Concurrently, these same systems can also raise potential safety hazards or
barriers to transportation. To address older operator and ITS issues, the
Intelligent Transportation Society of America's S&HF Committee has recently
initiated a new Subcommittee on Older Drivers and ITS. The FHWA is currently
addressing older operator and ITS issues, and as a member of the S&HF
Committee, FHWA has agreed to actively support this new subcommittee. This will
be in addition to FHWA's current support of TRB Committee A3B13, Safe Mobility
for Older Persons.
II. Aging Scenarios Data Needs
During the course of this strategic planning work it has become obvious that there is not a clear understanding of what the future holds for the aging baby-boom population. These individuals have grown up with a greater dependence on the automobile with 2+ car families being the rule than the exception. More women in this generation will have driven more extensively with more responsibility for the purchase and maintenance of their vehicle than has been true in prior generations. There may also be a tendency for this population to live further away from their place of employment, extended family members and goods and services. If people continue to retire in place this group may find themselves with greater mobility limitations once they stop or reduce their driving. However, most of the above is conjecture since there is no real data.
What is needed are longitudinal studies that follow an array of these
cohorts over a long period of time (25-35+ years) to determine how they actually
go about maintaining their mobility. The safety and mobility consequences of the
aging process on this cohort group can only be understood through the conduct of
such studies. These studies, if conducted on their own, can be quite expensive,
but, if done in coordination with and as add ons to existing longitudinal
studies, can be much less expensive. Fortunately, the federal government has
realized the need for coordination in this area and has established a Forum on
Aging Related Statistics that has attempted to provide a source to permit
collecting coordinated data for multiple applications. In this particular issue
area surveys such as the health and retirement survey asks some transportation
questions which could be extended in later surveys to develop a longer term
perspective. Information is needed on employment/volunteer activities,
retirement, patterns, fiscal patterns, living arrangements, transportation
arrangements, (particularly after driving), health practices and driving
capabilities, etc. This data should be collected in coordination with other
on-going or proposed long term studies. Data from these studies should also be
useful in the design and evaluation of systems to identify, assess, rehabilitate
and regulate those drivers who have functional limitations that may limit their
safe driving or use of other transportation systems.
III. Need to Improve Our Understanding of the Relationship Between Age, Medical Conditions, Functional Disabilities and Operator Performance
We have great difficulty in relating age-related changes in physiology and performance to the ability of the operator to maintain the required margin of safety while operating in the transportation system. While the FAA has established medical standards for pilots, this is less true for other modes. To date, we have little evidence of how the normal aging process or the interaction of age and disease interfere with an individual's ability to safely operate in the various transportation settings. There was general agreement concerning a need for additional research to develop an improved understanding of the relationship between the aging process and the performance of vehicle operators. This is especially true given the observation that people age at different rates and different body systems in the same person age at different rates.
Further, different predictors may be needed for males and females, as is documented in a review of empirical findings on measuring human functional aging by Anestey, Lord and Smith (1996) inExperimental Aging Research. "The results obtained by collating the correlations of biomarkers with age suggest that males and females should not be included as one group in functional age research; and where normative data is provided, this should be separate for males and females." (pg.261). Thus, there may be a need for gender specific norms relative to the aging process.
Stated in another way, it is clear that current information on the role of medical conditions and functional ability on crash involvement and operator performance is insufficient, and we can not develop clear guidelines on who should or should not drive. Also, evidence on the role of medications and safe driving is insufficient to enable physicians to prescribe the most cost effective safe medications. Therefore:
A.) There is need to continue to conduct epidemiological research on the relationship between and among medical conditions and functional disabilities and crash involvement and driving practices. Current knowledge does not permit clear guidelines because risk ratios for various conditions are either contradictory, too low or not actually appraised. There is an interaction between crash involvement and driving cessation that makes it difficult to provide clear guidance to physicians or to their patients.
B.) There is a need to determine how performance of operator tasks are related to medical conditions and functional disabilities. In addition to crash risk ratios the actual driving behavior of individuals with functional disabilities needs to be better understood. There are those who believe that the strategic and tactical decision that an individual makes are more important than their operating skills. There is a need to conduct research into these decision processes.
C.) There is a longstanding concern that medications may impair
driving. Persons 65+ received 29 percent of all prescriptions and more than 80
percent receive one or more medications. There is a need for a better
understanding of the role of medications. Physicians can often make therapeutic
choices that reduce or eliminate exposure to specific medications that adversely
effect driving. What is needed is information on what the adverse effects of
commonly used medications, most notably, tricyclic antidepressants,
benziodiazepine, and opioid analgesics.
IV. Developing New Driver-Aiding Technologies
The development of new technologies for aiding drivers and other operators may have been stifled by legal considerations. The legal problems are not related to the potential failure of the aid or device to function properly. They appear to result from the fact that an aid can allow an individual to operate a vehicle who would ordinarily be unable to do so.
The extension of liability beyond product quality seems to preclude major manufactures from developing and deploying innovations which could extend mobility to elderly operators. As an example the developers of driving aids used by handicapped operators appear to be almost entirely small after-market firms who produce custom products. These firms lack the research and development resources which may be required to advance these technologies. Further, because they engage in custom aftermarket work they have great difficulty in providing a truly integrated product. Their participation in theses markets may be possible only because they lack the resources to make them attractive targets for legal actions. The department should determine if innovation in this area is being hampered due to such liability exposure. If so it could examine legal innovations and remedies such as "Vaccine Pool" legislation.
Current advances in data acquisition and recording technology permit
the use of in situ evaluation systems. An analogy is the increased use of Holter
monitor technology to diagnosis medical conditions. This procedure connects
miniature portable sensors and recorders to the patient for a period of time.
The data collected permits evaluations of the patient as she or he goes about
their normal life. For the evaluation of elderly operators, a portable recording
system could be placed in his or her vehicle. This system would record visual,
positional, temporal, and other data about the driver's interaction with his or
her normal driving environment. This data could be used both to evaluate driving
skills and to identify areas for remediation. This new research area could
provide an important tool for extending mobility safely.
I. Expert Panel Participants
Aging Scenarios Expert Panel
Ann Arbor, Michigan
March 12-13, 1996
Barr, Robin
Deputy Associate Director, Extramural Affairs
National Institute on Aging
7201 Wisconsin Ave., Gateway 20218
Bethesda, MD 20892
PHONE: (301) 496-9322
FAX: (301) 402-2945
Burkhart, Jon
President
Ecosymetrics, Inc.
4715 Cordell Ave.
Bethesda, MD 20814-3016
PHONE: (301) 652-2414
FAX: (301) 907-8952
Hollmann, Dr. Frederick, W.
Statistician/Demographer
US Bureau of the Census
FOB 3, Room 2356
Washington, DC 20233
PHONE: (301) 457-2397
FAX: (301) 457-2481
E-MAIL: hollmann@census.gov
Hu, Patricia, S.
Oak Ridge National Laboratory
Box 2008, Building 3156, MS 6073
Oak Ridge, TN 37831-6073
PHONE: (423) 574-5284
FAX: (423) 574-3895
Juster, Dr. F. Thomas
Survey Research Center, Institute for Social Research
University of Michigan
PHONE: (313) 764-4207
Peterson, Dr. John
Michigan Office of Services to the Aging
P.O. Box 30026
Lansing, MI 48909
PHONE: (517) 373-8562
Rones, Philip
Bureau of Labor Statistics
Dept of Labor
Postal Square - Room 4675
2 Massachusetts Ave., NE
Washington, DC 20212
PHONE: (202) 606-6426
FAX: (202) 606-6425
Tull, Allan
Member, AARP Board of Directors
55 Bower Rd.
Madison, CT 06443
PHONE: (203) 245-7075
FAX: (203) 245-7420
Waller, Patricia F. (Local host as well as panelist)
Director, Transportation Research Institute
University of Michigan
2901 Baxter Rd.
Ann Arbor, MI 48109-2150
PHONE: (313) 764-6505
FAX: (313) 936-1081
Secretary Helen Albertson (313) 764-6505
Department of Transportation Steering Committee
Albala, David M., M.D.
White House Fellow
Office of the Secretary
Room 10200, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5459
FAX: (202) 366-7952
Eberhard, John W.
Senior Research Psychologist
Program Development and Evaluation, NTS-31
National Highway Traffic Safety Administration
Room 6240, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5595, 4003
FAX: (202) 366-7096
Nutter, Robert D.
Chief, Safety Division, P-13
Office of Environment, Energy and Safety
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-2916
FAX: (202) 366-7618
Trilling, Donald
Director, Office of Environment, Energy and Safety, P-10
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-4220
FAX: (202) 366-7618
E-MAIL: donald.trilling@ost.dot.gov
Volpe Project Staff
Skinner, David
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2696
FAX: (617) 494-3622
E-MAIL: skinner@volpe2.dot.gov
Stearns, Mary D.
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2617
FAX: (617) 494-3622
E-MAIL: stearnsm@volpe2.dot.gov
Sussman, E. Donald
Chief, Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2413
FAX: (617) 494-3622
E-MAIL: sussman@volpe1.dot.gov
Medical Expert Review Panel
Chicago, Illinois
March 21- 22, 1996
Dr. John Alpar
5311 West 9th Ave.
Amarillo, TX 79106
PHONE: (806) 359-3937
FAX: (806) 359-8124
Dr. Donald Dawson
Teamsters Medical Advisory Team
121 Marmion Way
Rockport, MA 01966
PHONE: (508) 546-9952
FAX: (508) 546-9952 (*must call first to say fax will be
sent)
Dr. David A. Drachman
professor and Chairman, Neurology
Univ. of Massachusetts Medical Center
55 Lake Avenue North
Worcester, MA 01655
PHONE: (508) 856-3081
FAX: (508) 856-6778
Dr. Richard Marottoli
Yale University, School of Medicine
333 Cedar Street
PO Box 3333
New Haven, CT 06510-8056
PHONE: (203) 785-3344
FAX: (203) 737-4209
E-MAIL: MAROTTOL@GWPO.YNHH.COM
Dr. Stanley R. Mohler
Professor and Vice Chairman, Director, Aerospace Medicine
Dept. of Community Health,
Wright State University School of Medicine
Box 927
Dayton, OH 45401
PHONE: (937) 276-8338
FAX: (937) 275-5420
Dr. Mary Moran
Assistant Professor, Department of Rheumatology University of Chicago
6000 West Touhy
Chicago, IL 60646 -1297
PHONE: (312) 763-1800
FAX: (312) 763-1146
Dr. Wayne A. Ray
Vanderbilt University
Dept. of Preventive Medicine
A -1128 Medical Center North
Nashville, TN 37232- 2637
PHONE: (616) 322-2017
FAX: (615) 343-8722
E-MAIL: wayne.ray@mcmail.vanderbilt.edu
Dr. Sheldon M. Retchin
MCV Associated Physicians
1001 East Broad Street, Suite 330
Richmond, VA 23219
PHONE: (804) 648-1705
FAX: (804) 649-3538
E-MAIL: retchin@gems.vcu.edu
RADM Alan M. Steinman, USCG
Chief, Office of Health and Safety Commandant (G- K) U.S. Coast Guard, Rm. 431
2100 2nd St., SW
Washington, DC 20593
PHONE: (202) 267-1098
FAX: (202) 267-4346
E-MAIL: K/G- K/G-K@CGSMTP.USCG.MIL
Dr. Ellison H. Wittels
Medical Director, Occupational Health Program Baylor College of Medicine
6560 Fannin, Suite 920
Houston, TX 77030
PHONE: (713) 798-3766
FAX: (713) 798-8076
Department of Transportation Steering Committee
Albala, David M., M.D.
White House Fellow
Office of the Secretary
Room 10200, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5459
FAX: (202) 366-7952
Eberhard, John W.
Senior Research Psychologist
Program Development and Evaluation, NTS-31
National Highway Traffic Safety Administration
Room 6240, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5595, 4003
FAX: (202) 366-7096
Schroeder, David, J.
Manager, Human Resources Research Division
FAA/ AAM-500
PO Box 25082
Oklahoma City, OK 73125
PHONE: (405) 954-6827
Trilling, Donald
Director, Office of Environment, Energy and Safety, P-10
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-4220
FAX: (202) 366-7618
E-MAIL: donald.trilling@ost.dot.gov
Volpe Project Staff
Skinner, David
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2696
FAX: (617) 494-3622
E-MAIL: skinner@volpe2.dot.gov
Human Factors and Technology Expert Panel
State College, PA
April 2-3, 1996
Ball, Karlene
Professor of Psychology
Western Kentucky University
236 Tate Page Hall
Bowling Green, KY 42101
PHONE: (502) 745-2094
FAX: (502) 745-4438
Lee, Eun
General Motors Corporation
3050 Mound Rd., MC 480-103-001
Warren, MI 48090-9055
PHONE: (810) 986-1653
FAX: (810) 986-0294
Mace, Douglas
President, The Last Resource
309 Armacast Road
Bellefont, PA 16823
PHONE: (814) 355-4479
FAX: (814) 355-5817
E-MAIL: l=LRI@IX.netcom.com
Perel, Michael
National Highway Traffic Safety Administration
Office of Crash Avoidance Research, NRD-52
Room 6220, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5675
Pietrushka, Martin
Assistant Professor of Civil Engineering and Faculty Associate
Pennsylvania Transportation Institute
Pennsylvania State University
Research Office Building
University Park, PA 16802
PHONE: (814) 863-3954
FAX: (814) 865-3039
E-MAIL: mtp5@psu.edu
Repa, Brian
General Motors Systems Engineering Center
1151 Crooks
Troy, MI 48084
PHONE: (810) 280-6768
FAX: (810) 289-7764
Schaie, K. Warner
Evan Pugh Professor of Human development and Psychology
Director, Gerontology Center
S. 105 Henderson
Penn State University
University Park, PA 16802
PHONE: (814) 863-9735
FAX: (814) 863-9423
Schieber, Frank
Associate Professor of Psychology
University of South Dakota
414 E. Clark Street
Vermillion, SD 57069
PHONE: (605) 677-6407
FAX: (605) 677-6604
Seidle, Norman
American Systems Corporation
14200 Hawk Meadow Drive
PO Box 10810
Chantilly, VA 22021-0810
PHONE: (703) 968-5118
FAX: (703) 968-5151
Smiley, Alison
President, Human Factors North, Inc.
118 Baldwin Street
Toronto M5T 1L6
Ontario, Canada
PHONE: (416) 596-1252
FAX: (416) 596-6946
Staplen, Loren
Scientific Corporation
PO Box 1367
1722 Sumneytown Pke.
Kulpsville, PA 19443
PHONE: (215) 412-4912
FAX: (215) 412-4911
E-MAIL: 75142.515@compuserve.com
Tsang, Pamela
Associate Professor of Psychology
Wright State University
309 Oelman
Dayton, OH 45435
PHONE: (513) 873-2469
FAX: (513) 873-3301
Local Hosts
Eddie C. Crow
Program Manager, Applied Research Laboratory
Penn State University
State College, PA 16802
PHONE: (814) 863-9887
FAX: (814) 863-0673
Wendy L. Gilpin
Assistant to Director, Applied Research Laboratory
Penn State University
PO Box 30
State College, PA 16804-0030
PHONE: (814) 865-6343
FAX: (814) 865-3105
E-MAIL: wlg5@psu.edu
Department of Transportation Steering Committee
Albala, David M., M.D.
White House Fellow
Office of the Secretary
Room 10200, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5459
FAX: (202) 366-7952
Eberhard, John W.
Senior Research Psychologist
Program Development and Evaluation, NTS-31
National Highway Traffic Safety Administration
Room 6240, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5595, 4003
FAX: (202) 366-7096
Nutter, Robert D.
Chief, Safety Division, P-13
Office of Environment, Energy and Safety
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-2916
FAX: (202) 366-7618
Schroeder, David, J.
Manager, Human Resources Research Division
FAA/ AAM-500
PO Box 25082
Oklahoma City, OK 73125
PHONE: (405) 954-6827
Trilling, Donald
Director, Office of Environment, Energy and Safety, P-10
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-4220
FAX: (202) 366-7618
E-MAIL: donald.trilling@ost.dot.gov
Volpe Project Staff
Skinner, David
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2696
FAX: (617) 494-3622
E-MAIL: skinner@volpe2.dot.gov
Stearns, Mary D.
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2617
FAX: (617) 494-3622
E-MAIL: stearnsm@volpe2.dot.gov
Sussman, E. Donald
Chief, Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2413
FAX: (617) 494-3622
E-MAIL: sussman@volpe1.dot.gov
Management Practices Expert Panel
Washington, D.C.
March 26-27, 1996
Lois Albarelli
Administration on Aging
Room 4745, Cohen Bldg.
330 Independence Ave., SW
Washington, DC 20201
Mr. Charles Gauthier
National Associates of State Directors of Transportation
1604 Longfellow Street
McLean, VA 22101
PHONE : (703) 734-1620
FAX: (703) 734-6203
FAX: (703) 734-1868
Mr. Doug Helton
AOPA
421 Aviation Way
Frederick, MD 21701
PHONE: (301) 695-2203
FAX: (301) 695-2214-2375
Ms. Jeanette M. Hercik
Council of Governors' Policy Advisors
400 North Capital Street
Suite 390
Washington, DC 20001
PHONE: (202) 624-5386
FAX: (202) 624-7846
Ms. Linda Hunt
Occupational Therapist, Program in Occupational Therapy
Washington University School of Medicine
4444 Forest Park Ave.
St. Louis, MO 63108
PHONE: (314) 286-1606
FAX: (314) 286-1601
Ms. Deena Garrison Jones
American Occupational Therapy Assn.
Woodrow Wilson Rehab Center - Box 477
Fisherville, VA 22939
PHONE: (540) 332-7118
FAX: (540) 337-0905
Mr. Arthur W. Kinsman
Manager of Government Relations, Public and Government Relations, AAA, MA
1050 Hingham State
Rockland, MA 02370
PHONE: (617) 723-0890
FAX: (617) 878-1096
Brian Mclaughlin
FHWA
Office of Motor Carrier Research
Room 3107
400 Seventh St., SW
Washington, DC 20590
Mr. Pete Nunnenkamp
DMV-Manager of Driver Programs
1905 Lane Ave., NE
Salem, OR 97314
PHONE: (503) 945-5088
FAX: (503) 945-5329
Ms. Elaine Petrucelli
Executive Director
Association for the Advancement of Automotive Medicine
2340 Des Plaines Ave., Suite 106
Des Plaines, IL 60018
PHONE: (708) 390-8927
FAX: (708) 390-9962
E-MAIL: AAAM1@aol.com
Dr. Karlene Roberts
University of California, School of Business Administration
350 Barrows Hall
Berkeley, CA 94611
PHONE: (510) 642-5221
FAX: (510) 642-4700
Mr. Bill Rogers
Director of Research
ATA Foundation
2200 Mill Road
Alexandria, VA 22314
PHONE: (703) 838-1700
FAX: (703) 838-0291
Charles J. Rueble
DOT/FAA/AAM-203
Nassif Bldg. Room 2406
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 266-1752
Mrs. Jane Stutts
University of North Carolina
Highway Safety Research Center
730 Airport Road
Bolin Creek, Suite 300
Chapel Hill, NC 27599-3430
PHONE: (919) 962-8717
Mr. Bob Unitas
EEOC Representative, Age Discrimination
1801 L Street, NW
Washington, DC 20507
PHONE: (202) 663-4768
Arthur L. Webster
8302 Westmont Terrace
Bethesda, MD 20817
PHONE: (301) 469-7342
Department of Transportation Steering Committee
Albala, David M., M.D.
White House Fellow
Office of the Secretary
Room 10200, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5459
FAX: (202) 366-7952
Eberhard, John W.
Senior Research Psychologist
Program Development and Evaluation, NTS-31
National Highway Traffic Safety Administration
Room 6240, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5595, 4003
FAX: (202) 366-7096
Nutter, Robert D.
Chief, Safety Division, P-13
Office of Environment, Energy and Safety
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-2916
FAX: (202) 366-7618
Trilling, Donald
Director, Office of Environment, Energy and Safety, P-10
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-4220
FAX: (202) 366-7618
E-MAIL: donald.trilling@ost.dot.gov
Charlene Wilder
USDOT/FTA/TRI-12
400 7th St., SW
Washington, DC 20590
PHONE: (202) 366-1077
Volpe Project Staff
Skinner, David
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2696
FAX: (617) 494-3622
E-MAIL: skinner@volpe2.dot.gov
Stearns, Mary D.
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2617
FAX: (617) 494-3622
E-MAIL: stearnsm@volpe2.dot.gov
Alternative Transportation Expert Panel
Washington, DC
9-10 April 1996
Burkhart, Jon
President
Ecosymetrics, Inc.
4715 Cordell Ave.
Bethesda, MD 20814-3016
PHONE: (301) 652-2414
FAX: (301) 907-8952
Freund, Katherine
President
Katherine Freund Associates, Inc.
Policy Analysis & Planning
309 Cumberland Ave.
Portland, ME 04101
PHONE: (207) 772-2077
FAX: (207) 772-2204
E-MAIL: kfreundinc@aol.com
Harman, Lawrence
L.J. Harman Consulting
45 Maple Ave.
Bridgewater, MA 02324
PHONE: (508) 697-4958
FAX: (508) 697-0383
Hemily, Brendon
Manager of Research and Technical Services
Canadian Urban Transit Association
55 York Street, Suite 901
Toronto, ON M5J 1R7
PHONE: (416) 365-9800
FAX: (416) 365-1295
Landy, Mike
Oats, Inc
PHONE: (816) 279-3131
FAX: (816) 279-5982
McSwain, Diane
U.S. Department of Health and Human Services
200 Independence Ave., SW
HHH Bldg. Room 630F
Washington, DC 20201
PHONE: (202) 401-5926
FAX: (202) 690-5672
Morgan, Hal
International Taxi Cab and Livery Association
3849 Farragut Ave.
Kensington, MD 20895
PHONE: (301) 946-5701
FAX: (301) 946-4641
Morris, Ann
American Occupational Therapy Association
PO Box 31220
Bethesda, MD 20824-1220
PHONE: (301) 652-6611 x2049
FAX: (301) 652-7711
Peterson, John
Division Director for Program Development
Michigan Services for the Aging
PO Box 30026
Lansing, MI 48909
PHONE: (517) 373-8562
FAX: (517) 373-4092
Raphael, David
Executive Director
Community Transportation Association
Association of America
1440 New York Avenue, NW, Suite 440
Washington, DC 20005
PHONE: (202) 628-1480
FAX: (202) 737-9197
Ronghi, Vincenzo E.
Executive Director
Massachusetts Services for Seniors Corp.
(Affiliated with The National Caucus and Center on Black Aged)
Massachusetts Services for Seniors Corp./ NCCBA
2808 Main St.
Springfield, MA 01107
PHONE: (413) 736-5468
FAX: (413) 737-2954
Stoes, Lisa
Technical Assistance and Training Administrator
Florida Commission for the Transportation Disadvantaged
2314 Dillon Ct.
605 Suwannee Street, MS-49
Tallahassee, FL 32399
PHONE: (904) 488-6036
FAX: (904) 922-7278
Straight, Audrey
AARP
Public Policy Institute
601 E. Street, NW
Washington, DC 20049
PHONE: (202) 434-3919
FAX: (202) 434-6402
Wartow, Nancy
Administration on Aging
PHONE: (202) 619-1058
FAX: (202) 260-1019
Department of Transportation Steering Committee
Albala, David M., M.D.
White House Fellow
Office of the Secretary
Room 10200, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5459
FAX: (202) 366-7952
Arrillaga, Bert
USDOT/FTA/TRI-12
400 7th St., SW
Washington, DC 20590
PHONE: (202) 366-0231
Eberhard, John W.
Senior Research Psychologist
Program Development and Evaluation, NTS-31
National Highway Traffic Safety Administration
Room 6240, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-5595, 4003
FAX: (202) 366-7096
Nutter, Robert D.
Chief, Safety Division, P-13
Office of Environment, Energy and Safety
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-2916
FAX: (202) 366-7618
Trilling, Donald
Director, Office of Environment, Energy and Safety, P-10
Office of the Assistant Secretary for Policy
Room 9222, Nassif Building
400 Seventh St., SW
Washington, DC 20590
PHONE: (202) 366-4220
FAX: (202) 366-7618
E-MAIL: donald.trilling@ost.dot.gov
Volpe Project Staff
Skinner, David
Operator Performance and Safety Analysis Division, DTS-45
Volpe National Transportation Systems Center
Kendall Square
Cambridge, MA 02142
PHONE: (617) 494-2696
FAX: (617) 494-3622
E-MAIL: skinner@volpe2.dot.gov
II. Other Participants
Departmental Steering Committee and Alternates
(in alphabetical order):
David Albala, M.D. White House Fellow
Bert Arrillage Federal Transit Administration
Jesse Blatt National Highway Traffic Safety Administration
Teresa Doggett Federal Highway Administration
Christy Dugan George Washington University
John Eberhard National Highway Traffic Safety Administration
Ron Knipling Federal Highway Administration
Chris Krusa Federal Maritime Administration
Alex Landsburg Federal Maritime Administration
Harold Lunenfeld Federal Highway Administration
Truman Mast Federal Highway Administration
Joe Moyer Federal Highway Administration
Bob Nutter Office of the Secretary of Transportation
Mike Perel National Highway Traffic Safety Administration
Tom Raslear Federal Rail Administration
David Schroeder Federal Aviation Administration
Donald Sussman Volpe National Transportation Systems Center
Donald Trilling, Chair Office of the Secretary of Transportation
Stewart Walker United States Coast Guard
Charlene Wilder Federal Transit Administration
Safety Division of the Office of the Assistant Secretary for Transportation Policy
Nancy Dimodica
Ira Laster
Lucia Lawrence
Bob Nutter
Jeanne O'Leary
Howard Serig
Bob Stein
Donald Trilling
Volpe National Transportation Systems Center
Nicholas Chechile
David Skinner
Mary Stearns
Donald Sussman
1. Many of the following project descriptions are drawn from the July 1996 Newsletter of the Committee on the Safe Mobility of Older Persons, A3B13, Transportation Research Board, National Research Council, 2101 Constitution Ave., NW, Washington, DC 20418.
2. National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation, 400 7th Street, SW, Washington, DC 20590, Contact: John Eberhard (202) 366-5595.
3. Federal Highway Administration (FHWA), U.S. Department of Transportation, 6300 Georgetown Pike, McLean, VA 22101, Contact: Truman Mast (703) 285-2404.
4. Federal Transit Administration (FTA), U.S. Department of Transportation, 400 7th Street, SW, Washington, DC 20590, Contact: Stewart McKeown (202) 366-0244.
5. DOT/DHHS Coordinating Council on Human Service Transportation, Office of Intergovernmental Affairs, Hubert Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201, Contact: Dianne McSwain (202) 401-5926.
6. University Transportation Centers Program (UTCP), U.S. Department of Transportation, 400 7th St., SW, Washington, DC 20590, Contact Elaine Joost (202) 366-5442.
7. National Institute on Aging (NIA), 7201 Wisconsin Avenue, Bethesda, MD 20892, Contact: Jared B. Jobe (301) 496-3137.
8. Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, Contact: Julie Russell (404) 488-4652.
9. National Institute on Alcohol Abuse and Alcoholism, The Wilico Building,
6000 Executive Blvd, Bethesda, MD 20892, Contact: James Vaughan (301) 443-4375.